No description available.

Background: The current goal of treatment after acute ischemic stroke is the increase of cerebral blood flow (CBF) in ischemic brain tissue. Intra-aortic balloon pump (IABP) counterpulsation in the setting of cardiogenic shock is able to reduce left ventricular afterload and increase coronary blood flow. The effects of an IABP on CBF have not been sufficiently examined. We hypothesize that the use of an IABP especially enhances cerebral blood flow in patients with pre-existing heart failure. Methods: In this pilot study, 36 subjects were examined to investigate the effect of an IABP on middle cerebral artery (MCA) transcranial Doppler (TCD) flow velocity change and relative CBF augmentation by determining velocity time integral changes (ΔVTI) in a constant caliber of the MCA compared to a baseline measurement without an IABP. Subjects were divided into two groups according to their left ventricular ejection fraction (LVEF): Group 1 LVEF >30% and Group 2 LVEF ≤30%. Results: Both groups showed an increase in CBF using an IABP. Patients with a LVEF ≤30% showed a significantly higher increase of ΔVTI in the MCA under IABP augmentation compared to patients with a LVEF >30% (20.9% ± 3.9% Group 2 vs.10.5% ± 2.2% Group 1, p<0,05). The mean arterial pressure (MAP) increased only marginally in both groups under IABP augmentation. Conclusions: IABP improves cerebral blood flow, particularly in patients with pre-existing heart failure and highly impaired LVEF. Hence, an IABP might be a treatment option to improve cerebral perfusion in selected patients with cerebral misperfusion and simultaneously existing severe heart failure.

End-stage conditions such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have shown some of the most dramatic increases in mortality in the developed world over the past 40 years. Both are therefore leading causes of morbidity and mortality worldwide and should be considered as a major economic and social burden that is both substantial and increasing. In these conditions, exercise therapy should play an integral part in maintaining the patient’s maximal level of independence and functioning, as well as slowing or possibly even stopping the progression of the condition. In this context the main objectives of these doctoral theses are: a. Proving the safety of different exercise modalities. b. Identifying the most effective exercise interventions in regards to clinical parameters. c. Proving the feasibility of outpatient rehabilitation programmes for these high risk populations. This work, therefore, combines three studies looking into the effects of non-pharmaceutical interventions – predominantly different exercise regimes in the two major conditions in the mortality statistics of CHF and COPD - both with a very poor prognosis. In conclusion it can be said that the results and experience of all three studies demonstrate the safe feasibility of different outpatient exercise interventions and suggest specific positive adaptations in patients with heart failure and COPD which also led to a lower hospitalisation rate. There are clear hints that the therapy spectrum could be supplemented significantly by specific training interventions. The financial implications for any health care system are also highly relevant.

HINTERGRUND: Im Zustand der Herzinsuffizienz sind die Plasmaspiegel des atrialen natriuretischen Peptids (ANP) erhöht. ANP wird durch Herzmuskelzellen bei atrialer (und dadurch kardiomyozytärer) Dehnung freigesetzt. Eine Reihe von Plasmafaktoren, welche bei der Herzinsuffizienz aktiviert sind, bewirken ebenfalls eine ANP-Freisetzung durch die Interaktion mit G(alpha-q)-gekoppelten Rezeptoren und der daraus resultierenden Aktivierung der Proteinkinase C (PKC). Ziel der vorliegenden Studie war es, im Vergleich von normalen und insuffizienten Rattenherzen die dehnungsinduzierte ANP-Sekretion sowie die Rolle der PKC bei der basalen ANP-Freisetzung zu analysieren. METHODIK: Durch Anlegen eines infrarenalen aortokavalen Shunts (4 Wochen) wurde eine volumeninduzierte Herzinsuffizienz in Wistar Ratten erzeugt. Die ANP-Freisetzung wurde am isoliert, retrograd perfundierten Herzmodell analysiert. Durch Umstellen auf anterograde Perfusion (Perfusionsdruck: 10mmHg) wurde eine atriale De! hnung induziert. Die Aktivierung der PKC fand durch Zugabe von PMA (Phorbol-12-Myristat-13-Azetat) zum Perfusat im Vergleich zu Vehikel statt. Alle Versuchsreihen wurden mit Herzen von shunt- sowie scheinoperierten Tieren durchgeführt. ERGEBNISSE UND DISKUSSION: Nach Shuntoperation war die ANP-Basalfreisetzung deutlich gesteigert und könnte die erhöhten ANP-Plasmaspiegel bei Patienten mit Herzinsuffizienz erklären. Dagegen wurde durch atriale Dehnung (als adäquaten Freisetzungsreiz am gesunden Herzen) keine weitere Steigerung der ANP-Freisetzung in der Shuntgruppe bewirkt. Die ANP-Freisetzung am insuffizienten Herzen ist im Vergleich zur normalen Herzfunktion somit verändert. Unter PKC-Stimulation sank die Freisetzung von ANP in der Shuntgruppe erheblich ab, wogegen es in der Kontrollgruppe zu keiner signifikanten Änderung der ANP-Sekretion kam. Damit wurde der Verdacht erhärtet, dass die Proteinkinase C in die abweichende Regulation der ANP-Freisetzung bei Herzinsuffizie! nz involviert ist. / BJECTIVE: Plasma levels of atrial natriuretic peptide (ANP) are markedly increased in congestive heart failure. ANP has been shown to be released by cardiomyocytes during atrial (and thereby cardiomyocytical) stretch. Several factors that are activated in heart failure as well enhance ANP release through the interaction with G(alpha-q)-coupled receptors and the consequent activation of proteinkinase C (PKC). The goal of this study was to analyse stretch induced ANP secretion and to investigate the involvement of PKC in the regulation of ANP release in heart failure compared to normal hearts. METHODS: Volume overload induced heart failure was produced by an infrarenal aortocaval shunt (4 weeks) in Wistar rats. ANP release was analysed in an isolated retrogradly perfused heart preparation. Atrial stretch was induced by switching to anterograd perfusion (perfusion pressure: 10mmHg). For PKC activation PMA (phorbol 12 myristate 13 acetate) was added to the perfusate and compar! ed to vehicle treatment. All experiments were performed with shunt and sham operated rats. RESULTS AND CONCLUSIONS: After shunt operation ANP baseline release was considerably augmented and could thus explain elevated ANP plasma levels in heart failure patients. In contrast, atrial stretch as an adequate secretion stimulus in control hearts did not further enhance ANP release in hearts of shunt operated animals. The ANP secretion in heart failure therefore seems to differ from the ANP secretion in the healthy state. Stimulation of PKC markedly decreased ANP release in the shunt group, whereas it did not have any significant effect on ANP release in the control group. In conclusion, the role of the proteinkinase C in ANP release differs between normal and failing hearts and seems to be involved in the deviating regulation of ANP release in states of heart failure.

Das Ziel dieser Arbeit war es einen geeigneten internen Standard für die linksventrikuläre mRNA-Quantifizierung bei kardialer Hypertrophie und Herzinsuffizienz in der Ratte zu finden. Die mRNA-Expression von GAPDH, 18SrRNA, Cyclophilin and Porphobilinogen-Desaminase (PBGD) wurde vier Wochen nach Induktion von Hypertrophie (kleiner aortokavaler Shunt) und Herzinsuffizienz (großer aortokavaler Shunt bzw. Myokardinfarkt) mit Hilfe des Ribonuklease Protektion Assay (RPA) und der TaqMan PCR bestimmt. Die linksventrikuläre ANP-mRNA-Expression war in allen untersuchten Modellen unabhängig von der angewendeten Detektionsmethode erhöht. Die mRNA-Expression der Housekeeping Gene mit Hilfe des RPA bestimmt, war in allen untersuchten Modellen im Vergleich zu den Kontrollen unverändert (GAPDH: kleiner Shunt: 105.1+-7.4, großer Shunt: 105.2+-6.8, MI: 88.4+-3.7; 18SrRNA: kleiner Shunt: 110.7+-8.2, großer Shunt: 104.4+-8.9, MI: 107.5+-12.0; Cyclophilin: kleiner Shunt: 96.4+-7.9, großer Shunt: 112.9+-4.9, MI: 95.7+-13.8; PBGD: kleiner Shunt: 81.9+-6.3, großer Shunt: 83.7+-4.7, MI: 79.8+-9.7; % Kontrolle). In der sehr sensitiven TaqMan PCR zeigte sich eine veränderte mRNA-Expression von GAPDH, PBGD und Cyclophilin, lediglich 18S wurde unverändert exprimiert (GAPDH: kleiner Shunt: 114.5+-18.7, großer Shunt: 133.6+-19.1, MI: 64.2+-6.2, p / The purpose of this study was to identify an appropriate left ventricular mRNA as internal standard in gene expression analysis in cardiac hypertrophy and heart failure in the rat. Expression levels of GAPDH, 18SrRNA, Cyclophilin and porphobilinogen desaminase (PBGD) were measured four weeks after induction of either cardiac hypertrophy (small aortocaval shunt) or heart failure (large aortocaval shunt or myocardial infarction) using Ribonuclease protection assay (RPA) and TaqMan PCR. The left ventricular expression of ANP mRNA was increased in all these experimental models independently of the used method. Using RPA the mRNA expression of all studied housekeeping genes was unchanged in all experimental models compared to controls (GAPDH: small shunt: 105.1+-7.4, large shunt: 105.2+-6.8, MI: 88.4+-3.7; 18SrRNA: small shunt: 110.7+-8.2, large shunt: 104.4+-8.9, MI: 107.5+-12.0; Cyclophilin: small shunt: 96.4+-7.9, large shunt: 112.9+-4.9, MI: 95.7+-13.8; PBGD: small shunt: 81.9+-6.3, large shunt: 83.7+-4.7, MI: 79.8+-9.7; % control). Using the TaqMan PCR as a much more sensitive method only 18SrRNA levels were unchanged whereas GAPDH, PBGD and Cyclophilin mRNA expression was regulated (GAPDH: small shunt: 114.5+-18.7, large shunt: 133.6+-19.1, MI: 64.2+-6.2, p

No description available.

No description available.

No description available.

No description available.

No description available.