Dietrich Pfeiffer

Leipzig University · Cardiology & Angiology

The left atrial appendage is a blind ending cardiac structure prone to blood stasis due to its morphology. This structure is a preferred region of thrombogenesis in relation to reduced myocardial contractility of the atrial wall. Blood stasis occurs primarily in low flow conditions. One of the tasks of echocardiography is the analysis of morphology...

The case of a 71-year-old male with end stage heart failure and severe mitral regurgitation is presented, where percutaneous indirect mitral annuloplasty was performed. During device implantation in the coronary sinus the circumflex artery was compromised at two anatomic locations, while the mitral regurgitation was efficiently reduced. After weigh...

Aims Percutaneous mitral annuloplasty (PMA) represents a new treatment option for secondary mitral regurgitation (SMR) being associated with higher morbidity and mortality. The present study was aimed to evaluate whether or not acute effects on SMR severity can quantitatively be assessed after PMA. Methods and results PMA was performed in 30 patie...

Der Schritt von der invasiven elektrophysiologischen Diagnostik von Arrhythmien zur interventionellen Behandlung – zur Katheterablation – lag von den Anfängen der His-Bündel-Elektrographie im Jahr 1967 an nahe. Dabei war das Zeitintervall von 15 Jahren zwischen Diagnostik und Therapie bei Arrhythmien sogar kürzer, als die Zeit, die zwischen der ers...

Purpose: The study compares the feasibility of the quantitative volumetric and semi-quantitative approach for quantification of chronic aortic regurgitation (AR) using different imaging modalities. Methods: left ventricular (LV) volumes, regurgitant volumes (RVol) and regurgitant fractions (RF) were assessed retrospectively by 2D, 3D echocardiog...

Die transösophageale Echokardiographie (TEE) ermöglicht im Vergleich zur transthorakalen Echokardiographie (TTE) die Akquisition von Bildsequenzen mit besserer räumlicher Auflösung infolge der Verwendung höherer Schallfrequenzen. Dadurch können prinzipiell Morphologie und Funktion vieler kardialer Strukturen in der TEE genauer als in der TTE analys...

Die Auswirkungen von Alkohol auf Arrhythmien sind dosisabhängig, unabhängig vom Nachweis einer kardiovaskulären Erkrankung oder einer Herzinsuffizienz und können Gesunde betreffen. Während Vorhofflimmern in seiner Wahrscheinlichkeit mit der Alkoholdosis zunimmt, kommen Ereignisse des plötzlichen Herztodes bei niedrigen Alkoholdosierungen eher selte...

Mitral valve annuloplasty via the coronary sinus (CS) is possible by the Carillon device which can create constricting force after insertion into the CS transmitted to the mitral valve and mitral annulus. To strategise this procedure the knowledge about the size and anatomy of the CS in relation to the mitral annulus is crucial. 30 consecutive pati...

Atrial Fibrillation (AF) is one of the main risk factors for cardio-embolic stroke. The aim of the present study was to define morphological and functional parameters of the left atrium (LA) and the LAA to get a better risk stratification regarding the stroke risk estimation in the low risk group according to the CHA2DS2-VASc-Score. In 331 patients...

In the present study different approaches for the evaluation of aortic regurgitation (AR) in patients with chronic AR and in patient after TAVI were analysed. 55 patients with chronic AR and 15 patients with AR after TAVI were analysed by the conventional approach, semi-quantitative parameters and global left ventricular (LV) peak systolic strain (...

The aim of the present study was to detect characteristic patterns of longitudinal strain curves in patients with Barlow's disease. Standardised transthoracic echocardiography was performed in patients with Barlow's disease (group I; n = 20) and in patients with mitral regurgitation due to Carpentier's classification type I (group II; n = 20). Stra...

Background: In the randomised TATORT-NSTEMI trial routine thrombus aspiration in comparison with standard percutaneous coronary intervention (PCI) did not reduce the primary endpoint of microvascular obstruction assessed by cardiac magnetic resonance imaging in patients with non-ST-elevation myocardial infarction (NSTEMI). So far, no data on long-...

The present study was carried out to test the feasibility of proximal right coronary artery (RCA) imaging and to detect proximal RCA narrowing and occlusion by 2D and 3D transthoracic echocardiography in comparison to coronary angiography (CA). Standardised 2D and 3D echocardiography were performed prior to CA in 97 patients with sinus rhythm. The...

Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter-defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at...

The echocardiographic analysis of mitral valve regurgitation should be performed on the foundation of standardized image data acquisition. Complete analysis of the morphological and structural changes requires documentation of additional sectional planes. The first task of echocardiography is to clarify the cause of the defect. The mitral valve reg...

History: A 32-year-old woman was admitted to the emergency department because of acute dyspnea and syncope. A few minutes before the onset of symptoms, she had self-administered an intravenous injection of one gram of heroin combined with grinded flunitrazepam tablets. Investigations: Signs of acute cor pulmonale were detected on transthoracic e...

Background Current guidelines recommend thrombus aspiration in patients with ST-elevation myocardial infarction (STEMI); however, there are insufficient data to unequivocally support thrombectomy in patients with non-STEMI (NSTEMI). Methods/Design The TATORT-NSTEMI (Thrombus Aspiration in ThrOmbus containing culpRiT lesions in Non-ST-Elevation Myo...

Purpose: The conventional parameter of systolic function is global left ventricular (LV) ejection fraction (EF), but this parameter will be replaced by global strain because it seems to be more robust. However, regional strain differences can have a significant impact on global strain. Thus, the aim of the present study was to evaluate the effect...

Background: Implantable cardioverter-defibrillators (ICDs) cannot prevent death from progressive heart failure or non-cardiac disease. Patients with ICDs may receive defibrillation therapy from their devices in the last days of their lives, when such therapy does not accord with the goal of palliative treatment, but rather lowers these patients' q...

Fragestellung: Eine fraktionelle Flussreserve (FFRmyo) myo-Grenzwert bei Patienten mit gestörter Myokardperfusion (Myokardinfarkt und/oder Hypertonie) bei 50%-igen LAD-Stenosen als Indikation zur PTCA und überprüften diese Entscheidung nach dem klinischen Follow-Up. Ergebnisse: Das mittlere Alter aller Patienten war 59 Jahre, 13 Patienten (65%) hat...

Most patients with hypertension will require treatment with at least two antihypertensive agents to achieve blood pressure (BP) control. This double-blind study evaluated the efficacy and safety of aliskiren/amlodipine single-pill combination (SPC) therapy in patients with mild-to-moderate hypertension who are inadequately responsive to amlodipine...

Elevated left ventricular (LV) pacing thresholds or phrenic nerve stimulation (PNS) might be possible reasons for absence of continuous and effective biventricular stimulation. This study investigated the benefit and clinical efficacy of the ability to choose one out of three different LV pacing vectors for the management of suboptimal LV pacing th...

The optimal timing of intervention in non-ST-elevation myocardial infarction (NSTEMI) remains uncertain. The aim of this multicentre trial was to assess whether an immediate invasive approach is superior to an early invasive or a selective invasive approach with respect to reduction of large infarction. Patients with NSTEMI were randomized to eithe...

A 57-year-old man with ischaemic cardiomyopathy was admitted to our institution with fever. The patient had undergone percutaneous mitral valve repair abroad 2 weeks before admission. Transthoracic and transoesophageal echocardiography (TTE/TEE) were performed, showing a mobile lesion (red arrows) originating from the implanted MitraClip mitral va...

Objectives This multicenter trial sought to assess the merits of facilitated percutaneous coronary intervention (PCI) versus primary PCI in an ST-segment elevation myocardial infarction (STEMI) network with long transfer distances in patients presenting early after symptom onset. Background Facilitated PCI with fibrinolysis might be beneficial in...

We report a case of a 35 year old male with severe deep vein thrombosis of the lower limb on both sides and pulmonary embolism. A Klinefelter's mosaic (47,XXY [81%]/48,XXXY [19%]) was diagnosed. Because no other cause for this thromboembolism was found, we assume that in part, it was caused by the Klinefelter's mosaic. In all male patients presenti...

We investigated the safety, feasibility and efficacy of the Occlutech devices for patent foramen ovale (PFO) and atrial septal defect (ASD) closure in a prospective trial. The retention discs of the PFO device (23 x 25 mm, 27 x 30 mm) are connected by a 3 mm waist in the center with only one right atrial side central pin. The left atrial disc is pr...

Aim of this study was the development of a flow cytometric assay to detect platelet activation using in vitro stimulation with physiological agonists. Therefore, in healthy subjects and insulin-dependent diabetics with and without microangiopathy (retinopathy and/or nephropathy) the surface expression density of fibrinogen receptor complex gpIIb/II...

In mammalian heart, connexin43 (Cx43) represents the predominant connexin in the working myocardium. As the beta-adrenoceptor is involved in many cardiac diseases, we wanted to clarify the pathway by which beta-adrenoceptor stimulation may control Cx43 expression. Cultured neonatal rat cardiomyocytes were stimulated with isoprenaline. Cx43 expressi...

Der deutliche Zuwachs an Patienten mit chronischen Erkrankungen bei gleichzeitig verbesserungswürdiger Koordination der unterschiedlichen Versorgungsebenen (mit diskontinuierlichen Prozessen und Redundanzen) resultiert in steigenden Belastungen für das deutsche Gesundheitssystem. Aktuelle technische Entwicklungen bieten bereits eine realistische Ba...

Background Atrial overdrive and optimized interatrial conduction time can reduce atrial fibrillation (AF). Increased ventricular stimulation results in a higher incidence of atrial fibrillation. Patients and methods In 25 patients with paroxysmal AF, a dual-chamber pacemaker (Identity DR 5370, St. Jude Medical) was implanted. Atrial leads were plac...

Atrial overdrive and optimized interatrial conduction time can reduce atrial fibrillation (AF). Increased ventricular stimulation results in a higher incidence of atrial fibrillation. In 25 patients with paroxysmal AF, a dual-chamber pacemaker (Identity DR 5370, St. Jude Medical) was implanted. Atrial leads were placed randomly either septal (n=12)...

Therapy with implantable pacemakers, cardioverter defibrillators (ICD), and devices for cardiac resynchronization (CRT) is performed by various medical and surgical specialists. With the change from implantation by thoracotomy to the transvenous approach, an increasing number of devices are implanted by cardiologists. The purpose of this paper is t...

Purpose: The aim of the present study was to characterise the morphology of patent foramen ovale (PFO) by a standardised protocol during transoesophageal echocardiography and to estimate the final and successful position of PFO-occluding devices (PFO-Star) by evaluation of parameters determined by echocardiography. The echoacardiographic parameter...

Therapy with implantable pacemakers, cardioverter defibrillators (ICD), and devices for cardiac resynchronization (CRT) is performed by various medical and surgical specialists. With the change from implantation by thoracotomy to the transvenous approach, an increasing number of devices are implanted by cardiologists. The purpose of this paper is t...

Therapy with implantable pacemakers, cardioverter defibrillators (ICD), and devices for cardiac resynchronization (CRT) is performed by various medical and surgical specialists. With the change from implantation by thoracotomy to the transvenous approach, an increasing number of devices are implanted by cardiologists. The purpose of this paper is t...

The changes in the demographic structure, the increasing multi-morbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of health care services with its discontinuous processes and redundancies will increase the economic burdens in the health care system. The latest...

Dieser Kommentar ist eine Übersetzung bzw. Zusammenfassung zu den „ACC/AHA/ESC 2006 Leitlinien zum Management von Patienten mit ventrikulären Arrhythmien und Prävention des plötzlichen Herztodes“. Ziel ist es, den aktuellen Erkenntnisstand zur Thematik zusammenzufassen, versehen mit Kommentaren und der Einordnung in die in Deutschland geübte Praxis...

We report the case of a 49-year-old female patient who was admitted stationary because of a left-sided paralysis which had appeared some hours before. An embolic occlusion of the right A. cerebri media turned out to be the cause. A paradoxical embolism could be assumed because of an existing deep vein thrombosis and an increased right-ventricular p...

ECG telemonitoring is the application of single- or multichannel ECGs transmitted by telephone to the physician or an expert center. This enables the control of the health status despite the spatial separation of patient and physician. Cardiac arrhythmias, palpitations of unknown causes, the outcome of antiarrhythmic drug therapy or interventional...

Changes in the demographic structure, increasing multimorbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of healthcare services with its discontinuous processes and redundancies will increase the economic burdens in the German health-care system. Recent develop...

Die Zunahme chronischer Erkrankungen bei einer gleichzeitig verbesserungswürdigen Koordination der unterschiedlichen Versorgungsebenen (mit diskontinuierlichen Prozessen und Redundanzen) resultieren in steigenden Belastungen für das Gesundheitssystem. Aktuelle technische Entwicklungen bieten bereits eine realistische Basis, Telemonitoring als zentr...

We investigated the safety, feasibility and usefulness for closure of PFO with the new nitinol meshwire PFO-occluder device (Occlutech Figulla-single layer occluder) with an unique braiding technology which allows a 50% reduction of meshwork material on the left atrial side in combination with a greater flexibility as compared to the Amplatzer occl...

We report the case of a 49-year-old female patient who was admitted stationary because of a left-sided paralysis which had appeared some hours before. An embolic occlusion of the right A. cerebri media turned out to be the cause. A paradoxical embolism could be assumed because of an existing deep vein thrombosis and an increased right-ventricular p...

Syncytial behavior of cardiac tissue is mainly controlled by the expression of cardiac gap junction proteins, and of these, connexin43 (Cx43) represents the predominant connexin in the working myocardium. Because the alpha(1)-adrenoceptor is involved in many cardiac diseases, the following experiments were performed to clarify the pathway whereby a...

Moderate hypotension during hemodynamically stable ventricular tachycardia (VT), leads to cerebral ischemia. Supplementation of d-ribose has been shown to improve cardiac metabolism. We hypothesized that cerebral ischemia during slow VT may lead to the expression of immediate early genes related to neurodegeneration. This expression may be prevente...

Echocardiography is a reliable and commonly used method to examine cardiac diseases. Recent employment of modern technologies provides new opportunities to study left ventricular (LV) remodeling after myocardial infarction (MI) also in small rodents. LV volumes as most important prognostic parameters can be estimated by noncontrast enhanced echocar...

OMRAN, H., et al.: Echocardiographic Imaging of Coronary Sinus Diverticula and Middle Cardiac Veins in Patients with Preexcitation Syndrome: Impact on Radiofrequency Catheter Ablation of Posteroseptal Accessory Pathways. To determine the value of echocardiography for identifying coronary sinus (CS) diverticula and middle cardiac veins (MCVs) in pat...

Recent experiments have demonstrated that pressure waves of several hundred atmospheres, which occur during excimer laser coronary angioplasty (ELCA), are reduced while ablating in saline in comparison to blood or contrast medium. We report the procedural outcome of ELCA (XeCI laser operating at 308 nm, 25–40 Hz, 40–60 mJ/mm2 fluence, and 135 nsec/...

Bimodal RR Interval Distribution, Introduction: Radiofrequency (RF) catheter modification of the AV node hi patients with atrial fibrillation (AF) is limited by an unpredictable decrease of the ventricular rate and a wish incidence of permanent AV block, A bimodal RR histogram has been suggested to serve as a predictor for successful outcome but th...

Complete ST-segment recovery (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients presenting soon after symptom onset is still a matter of debate. STR for patients treated by prehospital combination fibrinolysis or prehospital initiated facilitated percutaneous coro...

Since pacemakers first have been implanted in 1958 considerable technical progress has been achieved. The devices are more efficient today, have complex diagnostic functions, memory capacity and it is even possible to get telemetric software updates. Automatic mode switch due to changing heart rhythm, adaptation of AV-delay, auto sensing and auto s...

Background: QT dynamics is the adaptation of repolarization duration on heart rate. There are several automatic computer algorithms for Holter analysis to describe this process. Our study was performed to compare results of two averaging algorithms inherent in an automatic Holter QT module. Methods: Two different methods of the automatic QT module...

Since pacemakers first have been implanted in 1958 considerable technical progress has been achieved. The devices are more efficient today, have complex diagnostic functions, memory capacity and it is even possible to get telemetric software updates. Automatic mode switch due to changing heart rhythm, adaptation of AV-delay, auto sensing and auto s...

The aim of the present study was to characterise the morphology of patent foramen ovale (PFO) by a standardised protocol during transoesophageal echocardiography and to estimate the final and successful position of PFO-occluding devices (PFO-Star) by evaluation of parameters determined by echocardiography. The echoacardiographic parameters of septu...

The population of patients likely to respond to selected pacing algorithms for maintenance of sinus rhythm is unknown. The purpose of this study was to identify patients with specific onset patterns of paroxysmal atrial fibrillation (AF). Dual-chamber pacemakers with advanced diagnostic functions were implanted in 112 patients with conventional ind...

Antiarrhythmic drugs are commonly used with the implantable cardioverter/defibrillator to treat recurrent ventricular tachyarrhythmias. Since various antiarrhythmic drugs have been reported to alter defibrillation threshold, an important question is whether the device will provide adequate energy for defibrillation during long-term follow-up and to...

Gap junction channels are essential for intercellular electrical communication in the heart. The most important cardiac gap junction proteins are connexin43 (predominantly) (Cx43), connexin40 (Cx40), and in early developmental stages connexin45. Since catecholamines play an important role in cardiac (patho)physiology, we wanted to elucidate whether...

The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden. There are few data identifying which patients might benefit most from which preventive pacing algorithms. Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker thera...

Ohne Zusammenfassung

Die medikamentöse Behandlung von Vorhofflimmern (AF) basiert auf der Therapie von Grundkrankheit und eingeschränkter Hämodynamik und wird durch die antiarrhythmische Therapie ergänzt. Die Entscheidung für Rhythmus- oder Frequenzkontrolle muss individuell erfolgen. Alle Patienten mit nicht sicher stabilem Sinusrhythmus bedürfen einer Thrombemboliepr...

Der plötzliche Herztod ist eine der häufigsten Todesursachen. In Deutschland überleben weniger als 10 % aller Betroffenen eine kardiopulmonale Reanimation. Die Prognose eines Betroffenen wird wesentlich durch das Verhalten zufälliger Zeugen bestimmt. In einer repräsentativen Bevölkerungsstichprobe wurden 1007 (462 Männer, 545 Frauen, Altersmedian 3...

Early and complete reperfusion is the main treatment goal in ST-elevation myocardial infarction (STEMI). The timely optimal reperfusion strategy might be a pre-hospital initiated pharmacological reperfusion with subsequent facilitated percutaneous coronary intervention (PCI). This approach has been compared with pre-hospital combination-fibrinolysi...

The coronary subclavian-steal-syndrome is a rare cause for angina pectoris following A. mammaria interna bypass operation. A 72-year-old male patient presented with vertigo and angina pectoris. A three vessel coronary artery disease was known and coronary artery surgery with three aortocoronary bypasses had been performed a year prior to presentati...

Das koronare Subclavian-Steal-Syndrom ist eine seltene Ursache pektanginser Beschwerden nach einer A.-mammaria-interna-Bypassoperation. Im Folgenden wird ber einen 72-jhrigen Patienten mit Schwindel sowie pektanginsen Beschwerden bei bekannter, mit einer Dreifachbypassoperation versorgter koronarer Dreigeferkrankung berichtet. Klinisch auffllig war...

Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients wit...

Cardiac manifestations were observed in patients with rheumatoid arthritis and other collagenoses. Echocardiography is a method of choice to detect pathologies in morphology and function of the heart. Pathophysiologically inflammatory alterations of the endo- as well as perimyocardium can be explained in these patients. In addition, in patients wit...

Important goals, when implanting a cardiac resynchronization therapy (CRT) system, are to reach a stable LV lead position in a suitable coronary sinus (CS) tributary associated with a low capture threshold and no extracardiac stimulation. The aim of this study was to assess the 2-year performance of a new preshaped lead designed for LV stimulation....

Gap junction channels form the basis of intercellular communication in the heart. In the working myocardium, the connexin43 (Cx43) is most abundantly found, whereas connexin40 (Cx40) is expressed in the atria and in the conduction system [together with low levels of connexin45 (Cx45)]. However, little is known about the differential regulation of t...

Myocardial perfusion can be analyzed by the first pass of Doppler intensity (DI) signals in the myocardium by myocardial contrast echocardiography with triggered power Doppler harmonic imaging (PDHI). DI versus time plots during 1:1 triggering was acquired during a mechanically standardized intravenous bolus application of Levovist (400 mg ml(-1);...

Using a previously published algorithm we hypothesize that myocardial contrast echocardiography (MCE) with power Doppler harmonic imaging (PDHI) is able to detect regional hypoperfusion within the territory of the left anterior descending artery (LAD) using intravenous (i.v.) injection of contrast in patients (pts) with coronary syndrome at rest. F...

Myocardial contrast echocardiography using power Doppler harmonic imaging is able to document myocardial hypoperfusion. Two case reports demonstrate the potential of intravenous bolus application of microbubbles in patients with acute chest pain due to myocardial ischaemia to detect regional low flow conditions. The case reports will focus on the n...