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Abstract

B. Gremmler, K. Kisters, C. Funke, H. Schleiting, M. Kunert and L.J. Ulbricht

Abstract

M. Kunert¹, B. Gremmler¹, H. Schleiting¹, R. Susilo², U.P. Strauss² and L.J. Ulbricht¹,³

¹Marienhospital Bottrop, Department of Cardiology, Bottrop, ²Trommsdorff Arzneimittel GmbH, Research & Development, Alsdorf, and ³University of Witten/Herdecke, Germany
Reperfusion arrhythmias represent a risk factor for death of post infarct patients receiving revascularization therapy, such as percutaneous transluminal angioplasty (PTCA). A relative deficiency of potassium (K+) and magnesium ions (Mg2+) has been shown to represent risk factors for certain types of arrhythmia. The aim of the present study was to assess the efficacy of a combined treatment with both cations in acutely infarcted patients receiving PTCA, regarding the occurrence of heart rhythm disorders and left ventricular function. Potassium/magnesium-therapy was initiated before (early-onset), and maintained during and up to 12 weeks after performance of PTCA. The study was designed as monocentric, prospective, placebo-controlled and double-blind. A total of 262 patients were enrolled in the study. An interim analysis revealed no differences between both study groups of treatment regarding primary outcome parameters: 1) Incidence of accelerated ventricular rhythm, 2) Incidence of ventricular tachycardia and ventricular fibrillation, and 3) Ejection fraction. Therefore, according to the protocol, the study was interrupted. However, a retrospective subanalysis of ECG-recordings revealed a significant reduction of ventricular extrasystoles and couplets in the K+/Mg2+-group. Both study groups were equal regarding quality and quantity of adverse events.Correspondence to:
Dr. M. Kunert
Department of Cardiology
Marienhospital Bottrop
Josef-Albers-Straße 70
46236 Bottrop, Germany
Email: [email protected]

Abstract

B. Gremmler¹,⁴, K. Kisters², M. Hausberg³, M. Kunert¹ and L.J. Ulbricht¹,⁴

¹Department of Cardiology, Marienhospital Bottrop, ²Department of Medicine, St. Anna Hospital Herne, ³AKTE Arbeitskreis Trace Elements and Electrolytes, ⁴University of Witten/Herdecke, Germany
Background: Abnormalities of diastolic function are first signs of cardiac remodeling in hypertension. Despite sufficient long-term antihypertensive treatment, a diastolic dysfunction concerning left ventricular relaxation is observed in many cases. Doppler echocardiography has become well-accepted as reliable, reproducible and a practical noninvasive method for diagnosis and longitudinal follow-up of patients with these diastolic dysfunctions. Since it was shown that dipyridamole treatment increased vasodilatorstimulated phosphoprotein Ser239phosphorylation (VASP), a benefit concerning diastolic dysfunction could be indirectly possible by dipyridamole-induced endothelial resistance reduction. Methods: Prospective observation of 11 long-term successfully pretreated, hypertensive patients with abnormal relaxation in the mitral inflow velocity curve. Patients with coronary artery disease, reduced cardiac ejection fraction, disease of valves or E-F deceleration time lower than 240 ms were excluded. The measurement of the ratio between peak early flow velocity (E) and peak late transmitral flow velocity (A) (E/A ratio) was carried out before and under additional dipyridamole treatment (200 mg sustained release twice daily). There was no change of continual antihypertensive medication during the observation time (12.6 ± 4.7 d). Results: A significant amelioration of the E/A ratio from 0.68 ± 0.11 to 0.81 ± 0.12 was observed (p = 0.017). No relevant change of blood pressure values was registered. Discussion: The additional treatment of sustained release dipyridamole to the continual antihypertensive medication shows a significant improvement of diastolic dysfunction already in a small patient group. This improvement was demonstrated by analysis of Doppler-echographic measurement (E/A ratio). Since there was no affect concerning blood pressure behavior, a greater clinical observation may be justified.Correspondence to:
Dr. med. B. Gremmler, PD Dr. med. L.J. Ulbricht
Marienhospital, Josef-Albers-Straße 70, 46236 Bottrop
Email: dr.bernhard.gremmler@ t-online.de

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