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Article: Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunction.

Gaasch, W H

1994 Volume 271, Issue 16, Page(s) 1276–1280

Abstract: Data from large and small clinical trials reflect major differences in the pathophysiology, treatment, and prognosis of left ventricular (LV) systolic and diastolic dysfunction. These studies also indicate that medical therapy can benefit patients with ... ...

Abstract	Data from large and small clinical trials reflect major differences in the pathophysiology, treatment, and prognosis of left ventricular (LV) systolic and diastolic dysfunction. These studies also indicate that medical therapy can benefit patients with LV dysfunction regardless of whether or not they are symptomatic. Because the descriptive term congestive heart failure does not provide for these important distinctions, a new classification of LV dysfunction has been developed in which patients with LV dysfunction are categorized on the basis of normal or abnormal systolic function. This classification is based on a simple assessment of LV function, it is applicable to patients without symptoms, and it reflects differences in treatment and prognosis. Those with clinically significant LV systolic dysfunction (ie, an LV ejection fraction < 40%) benefit from therapy whether or not they have symptoms of heart failure. Those with LV dysfunction and a normal LV ejection fraction (ie, diastolic dysfunction) also benefit from medical therapy. Annual mortality is higher in those with systolic dysfunction than in those with diastolic dysfunction, but within each of these categories mortality is higher in those with symptoms than in those without. This classification can be useful in the diagnosis and treatment of individual patients as well as in epidemiologic surveys designed to assess medical practice patterns.
MeSH term(s)	Diastole/physiology ; Heart Failure/classification ; Heart Failure/diagnosis ; Heart Failure/physiopathology ; Heart Failure/therapy ; Humans ; Systole/physiology ; Ventricular Function, Left/physiology
Language	English
Publishing date	1994-04-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2958-0
ISSN	1538-3598 ; 0098-7484 ; 0254-9077 ; 0002-9955
ISSN (online)	1538-3598
ISSN	0098-7484 ; 0254-9077 ; 0002-9955
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Ua VI Zs.88: Show issues

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Article: Congestive heart failure in patients with normal left ventricular systolic function: a manifestation of diastolic dysfunction.

Gaasch, W H

Herz

1991 Volume 16, Issue 1, Page(s) 22–32

Abstract: Diastolic dysfunction is a relatively common problem that may be mild and asymptomatic or may present with congestive heart failure and severe disabling symptoms. It is frequently due to coronary artery disease or left ventricular hypertrophy and it is ... ...

Abstract	Diastolic dysfunction is a relatively common problem that may be mild and asymptomatic or may present with congestive heart failure and severe disabling symptoms. It is frequently due to coronary artery disease or left ventricular hypertrophy and it is especially common in the older population. The pathophysiology is related to increased left ventricular passive stiffness and impaired or slowed myocardial relaxation. Patients with diastolic dysfunction are best treated with calcium channel blocking agents or beta-blocking agents (drugs that are generally avoided in patients with significant systolic dysfunction). Most treatment is based on symptomatic relief, and therefore periods of cautious trial and error are the rule. Congestive symptoms are treated with agents that reduce pulmonary venous pressure; in general positive inotropic agents and arterial vasodilators are not useful in heart failure that is due to diastolic dysfunction.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Diastole/drug effects ; Diastole/physiology ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Hemodynamics/drug effects ; Hemodynamics/physiology ; Humans ; Ventricular Function, Left/drug effects ; Ventricular Function, Left/physiology
Chemical Substances	Adrenergic beta-Antagonists ; Calcium Channel Blockers
Language	English
Publishing date	1991-02
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	8262-4
ISSN	1615-6692 ; 0340-9937 ; 0946-1299
ISSN (online)	1615-6692
ISSN	0340-9937 ; 0946-1299
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Zs.A 1270: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 426: Show issues

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Article: Appetite-suppressing drugs and valvular heart disease.

Cannistra, L B / Gaasch, W H

Cardiology in review

2001 Volume 7, Issue 6, Page(s) 356–361

Abstract: The popular diet drugs, fenfluramine and dexfenfluramine, were withdrawn from the market in the United States after the publication of an association of these drugs with valvulopathy in a small series of patients, spontaneous reports to the Food and Drug ...

Abstract	The popular diet drugs, fenfluramine and dexfenfluramine, were withdrawn from the market in the United States after the publication of an association of these drugs with valvulopathy in a small series of patients, spontaneous reports to the Food and Drug Administration, and echocardiographic surveys that suggested a valvulopathy prevalence of 32.8% among diet drug users. Subsequent publications suggested that there is an association of these agents with valvulopathy, but that the prevalence seems lower than initially suspected. This review examines the available prevalence data and attempts to account for some of the variability in these data. Potential pathophysiologic mechanisms are discussed and management guidelines for these patients are provided. This is an area of ongoing study and more information about the natural history of these lesions will certainly be forthcoming. A review of the data reveals that the withdrawal of these agents was prudent and likely prevented further harm.
MeSH term(s)	Appetite Depressants/adverse effects ; Dexfenfluramine/adverse effects ; Echocardiography ; Fenfluramine/adverse effects ; Heart Valve Diseases/chemically induced ; Heart Valve Diseases/diagnostic imaging ; Heart Valve Diseases/epidemiology ; Humans ; Phentermine/adverse effects ; Prevalence ; Serotonin Receptor Agonists/adverse effects ; United States/epidemiology
Chemical Substances	Appetite Depressants ; Serotonin Receptor Agonists ; Fenfluramine (2DS058H2CF) ; Phentermine (C045TQL4WP) ; Dexfenfluramine (E35R3G56OV)
Language	English
Publishing date	2001-01-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1294965-6
ISSN	1061-5377
ISSN	1061-5377
DOI	10.1097/00045415-199911000-00014
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Zs.A 4491: Show issues

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Article: Diastolic dysfunction of the left ventricle: importance to the clinician.

Gaasch, W H

Advances in internal medicine

1990 Volume 35, Page(s) 311–340

Abstract: Diastolic dysfunction is a relatively common problem that may be mild and asymptomatic or may present with severe disabling symptoms. It is frequently due to coronary artery disease and/or LV hypertrophy and it is especially common in the older ... ...

Abstract	Diastolic dysfunction is a relatively common problem that may be mild and asymptomatic or may present with severe disabling symptoms. It is frequently due to coronary artery disease and/or LV hypertrophy and it is especially common in the older population. Patients with diastolic dysfunction and normal systolic function are best treated with calcium channel blocking agents or beta-blocking agents (drugs that are generally avoided in patients with significant systolic dysfunction). These drugs are used in the same dosage as is used in patients with angina or hypertension. Most treatment is based on symptomatic relief, and therefore periods of cautious trial and error are the rule. When diastolic dysfunction is associated with systolic dysfunction, it may be necessary to treat both conditions, but in general, positive inotropic agents and arterial vasodilators are not useful in patients with diastolic dysfunction.
MeSH term(s)	Cardiomegaly/physiopathology ; Coronary Disease/drug therapy ; Coronary Disease/physiopathology ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Myocardial Contraction ; Stroke Volume/physiology
Language	English
Publishing date	1990
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	159-4
ISSN	0065-2822
ISSN	0065-2822
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Ua VI Zs.274: Show issues

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Article: Valve disease and diet pills--where do we stand?

Aurigemma, G P / Gaasch, W H

American family physician

1998 Volume 57, Issue 4, Page(s) 656, 659–60

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Appetite Depressants/adverse effects ; Dopamine Agents/adverse effects ; Drug Therapy, Combination ; Echocardiography ; Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/prevention & control ; Fenfluramine/adverse effects ; Heart Valve Diseases/chemically induced ; Heart Valve Diseases/complications ; Heart Valve Diseases/diagnostic imaging ; Humans ; Middle Aged ; Obesity/drug therapy ; Phentermine/adverse effects ; Serotonin Agents/adverse effects
Chemical Substances	Appetite Depressants ; Dopamine Agents ; Serotonin Agents ; Fenfluramine (2DS058H2CF) ; Phentermine (C045TQL4WP)
Language	English
Publishing date	1998-02-15
Publishing country	United States
Document type	Editorial
ZDB-ID	412694-4
ISSN	0002-838X ; 0572-3612
ISSN	0002-838X ; 0572-3612
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Zs.B 848: Show issues

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Article ; Online: Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage.

Ianosi, B / Gaasch, M / Rass, V / Huber, L / Hackl, W / Kofler, M / Schiefecker, A J / Addis, A / Beer, R / Rhomberg, P / Pfausler, B / Thomé, C / Ammenwerth, E / Helbok, R

European journal of neurology

2018 Volume 26, Issue 2, Page(s) 333–341

Abstract: ... recommended by guidelines, but rarely started within 48 h. We aimed to analyze the effect of early (within 48 ... h) versus late (>48 h) DVT prophylaxis on hematoma expansion (HE) and outcome in patients ... neuroimaging within 48 h and day 3-6. Multivariate analysis was performed to identify risk factors for late ...

Abstract	Background and purpose: Early pharmacological deep vein thrombosis (DVT) prophylaxis is recommended by guidelines, but rarely started within 48 h. We aimed to analyze the effect of early (within 48 h) versus late (>48 h) DVT prophylaxis on hematoma expansion (HE) and outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: We analyzed 134 consecutive patients admitted to a tertiary neurointensive care unit with diagnosed spontaneous ICH, without previous anticoagulation, severe coagulopathy, hematoma evacuation, early withdrawal of therapy or ineligibility for DVT prophylaxis according to our institutional protocol. Significant late HE was defined as ≥6 mL increase of hematoma volume between neuroimaging within 48 h and day 3-6. Multivariate analysis was performed to identify risk factors for late HE, poor 3-month outcome (modified Rankin Scale score ≥ 4) and mortality. Results: Patients had a median Glasgow Coma Scale score of 14 [interquartile range (IQR), 10-15], ICH volume of 11 (IQR, 5-24) mL and were 71 (IQR, 61-76) years old. A total of 56% (n = 76) received early DVT prophylaxis, 37% (n = 50) received late DVT prophylaxis and 8 (6%) had unknown bleeding onset. Patients with early DVT prophylaxis had smaller ICH volume [9.5 (IQR, 4-18.5) vs. 17.5 (IQR, 8-29) mL, P = 0.038] and were more often comatose (26% vs. 10%, P = 0.025). Significant late HE [n = 5/134 (3.7%)] was associated with larger initial ICH volume (P = 0.02) and lower thrombocyte count (P = 0.03) but not with early DVT prophylaxis (P = 0.36). Early DVT prophylaxis was not associated with worse outcome. Conclusion: Significant late HE is uncommon and DVT prophylaxis within 48 h of symptom onset may be safe in selected patients with ICH.
MeSH term(s)	Aged ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; Cerebral Hemorrhage/complications ; Enoxaparin/adverse effects ; Enoxaparin/therapeutic use ; Female ; Glasgow Coma Scale ; Hematoma/etiology ; Humans ; Male ; Middle Aged ; Risk Factors ; Thrombolytic Therapy/adverse effects ; Venous Thrombosis/drug therapy ; Venous Thrombosis/prevention & control
Chemical Substances	Anticoagulants ; Enoxaparin
Language	English
Publishing date	2018-12-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1280785-0
ISSN	1468-1331 ; 1351-5101 ; 1471-0552
ISSN (online)	1468-1331
ISSN	1351-5101 ; 1471-0552
DOI	10.1111/ene.13830
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Zs.A 4738: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 592: Show issues

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Article: Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves.

Levine, H J / Gaasch, W H

Journal of the American College of Cardiology

1996 Volume 28, Issue 5, Page(s) 1083–1091

Abstract: This review examines the results of vasodilator therapy in patients with chronic regurgitant lesions of the aortic and mitral valves. The analysis includes those studies which provide data on hemodynamic measurements, left ventricular systolic function, ... ...

Abstract	This review examines the results of vasodilator therapy in patients with chronic regurgitant lesions of the aortic and mitral valves. The analysis includes those studies which provide data on hemodynamic measurements, left ventricular systolic function, ventricular volumes and regurgitant flow. In patients with chronic aortic or mitral regurgitation, the short-term administration of nitroprusside, hydralazine, nifedipine or an angiotensin-converting enzyme (ACE) inhibitor produces salutary hemodynamic effects. The major difference in the response to combined preload and afterload reduction (i.e., nitroprusside) in patients with aortic versus mitral regurgitation was that forward stroke volume generally increased and ejection fraction remained unchanged in mitral regurgitation, whereas ejection fraction generally increased and forward stroke volume remained unchanged in aortic regurgitation. These observations suggest that a reciprocal relation between regurgitant and forward flow characterizes the response to preload and afterload reduction in mitral regurgitation (through a preload-dependent dynamic regurgitant orifice), whereas correction of afterload mismatch dominates the response in aortic regurgitation. In studies of long-term vasodilator therapy in patients with chronic aortic regurgitation, a reduction in left ventricular volumes and regurgitant fraction, with or without an increase in ejection fraction, has been observed during treatment with hydralazine, nifedipine and ACE inhibitors. Patients with the largest, sickest hearts generally benefit the most from treatment with vasoactive drugs. Nonetheless, favorable ventricular remodeling has been reported in asymptomatic patients, and long-term nifedipine use has delayed the need for operation in asymptomatic patients with chronic aortic regurgitation. For patients with chronic mitral regurgitation, definition of the etiology of the lesion is a prerequisite for choosing appropriate therapy. Excluding patients with obstructive hypertrophic cardiomyopathy and mitral valve prolapse, and some with fixed-orifice (i.e., rheumatic) mitral regurgitation, the signal importance of preload reduction suggests that the preferred long-term therapy for symptomatic chronic mitral regurgitation is an ACE inhibitor. There are no long-term studies that support the use of vasodilator therapy in asymptomatic patients with chronic mitral regurgitation.
MeSH term(s)	Aortic Valve Insufficiency/drug therapy ; Aortic Valve Insufficiency/physiopathology ; Chronic Disease ; Humans ; Mitral Valve Insufficiency/drug therapy ; Mitral Valve Insufficiency/physiopathology ; Time Factors ; Vasodilator Agents/therapeutic use
Chemical Substances	Vasodilator Agents
Language	English
Publishing date	1996-11-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/S0735-1097(96)00288-4
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 196: Show issues

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Article: The management of mitral valve disease.

Gaasch, W H / Eisenhauer, A C

Current opinion in cardiology

1996 Volume 11, Issue 2, Page(s) 114–119

Abstract: Clinical investigators continue to make significant advancements in the diagnosis and treatment of patients with mitral valve disease. The salutary effects of mitral balloon valvotomy for mitral stenosis and the development of a reasonable approach to ... ...

Abstract	Clinical investigators continue to make significant advancements in the diagnosis and treatment of patients with mitral valve disease. The salutary effects of mitral balloon valvotomy for mitral stenosis and the development of a reasonable approach to the asymptomatic patient with chronic mitral regurgitation are examples of relevant research that affects clinical outcomes. Recent developments in the management of patients with mitral valve disease are reviewed.
MeSH term(s)	Catheterization ; Echocardiography ; Exercise Test ; Hemodynamics/physiology ; Humans ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/physiopathology ; Mitral Valve Insufficiency/therapy ; Mitral Valve Stenosis/diagnosis ; Mitral Valve Stenosis/physiopathology ; Mitral Valve Stenosis/therapy ; Treatment Outcome
Language	English
Publishing date	1996-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645186-x
ISSN	1531-7080 ; 0268-4705
ISSN (online)	1531-7080
ISSN	0268-4705
DOI	10.1097/00001573-199603000-00003
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Zs.A 2556: Show issues

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Article: Management of aortic valve disease.

Gaasch, W H

Hospital practice (Office ed.)

1982 Volume 17, Issue 9, Page(s) 133–138

Abstract: The patient with severe aortic valve disease and significant symptoms is a clear-cut candidate for valve replacement surgery. Management of asymptomatic patients with aortic valve disease is less clear-cut. Because asymptomatic patients for the most part ...

Abstract	The patient with severe aortic valve disease and significant symptoms is a clear-cut candidate for valve replacement surgery. Management of asymptomatic patients with aortic valve disease is less clear-cut. Because asymptomatic patients for the most part have a benign prognosis, careful individual evaluation for risk of progressive disease must be weighed against the risks of surgery.
MeSH term(s)	Adult ; Aortic Valve/surgery ; Aortic Valve Insufficiency/physiopathology ; Aortic Valve Insufficiency/surgery ; Aortic Valve Stenosis/etiology ; Aortic Valve Stenosis/physiopathology ; Aortic Valve Stenosis/surgery ; Electrocardiography ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis/mortality ; Humans ; Risk
Language	English
Publishing date	1982-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2570453-9
ISSN	2377-1003 ; 8750-2836 ; 2154-8331
ISSN (online)	2377-1003
ISSN	8750-2836 ; 2154-8331
DOI	10.1080/21548331.1982.11702373
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Zs.B 890: Show issues

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Article: Gender differences in older patients with pressure-overload hypertrophy of the left ventricle.

Aurigemma, G P / Gaasch, W H

Cardiology

1995 Volume 86, Issue 4, Page(s) 310–317

Abstract: Left ventricular hypertrophy is an adaptive response to increased intraventricular pressure, and is consistently encountered in patients with hypertension or aortic stenosis. While it has long been appreciated that the extent of hypertrophy correlates ... ...

Abstract	Left ventricular hypertrophy is an adaptive response to increased intraventricular pressure, and is consistently encountered in patients with hypertension or aortic stenosis. While it has long been appreciated that the extent of hypertrophy correlates positively with the level of pressure, the age of the individual, and with indices of body size, recent evidence suggests that left ventricular structure and function also varies with gender. Elderly women with aortic stenosis, in several recent studies, have been shown to develop more marked concentric hypertrophy, lower levels of wall stress, and higher indices of systolic function. Similarly, in recent studies of extreme hypertensive hypertrophy, there is a strong female preponderance. The explanation for these findings is not clear at present, though it is possible that men with extensive hypertrophy have succumbed to complications of vascular disease at an earlier age. The syndrome of extreme hypertrophy complicating hypertension and aortic stenosis, more commonly seen in women, requires a carefully tailored clinical approach.
MeSH term(s)	Age Factors ; Aortic Valve Stenosis/complications ; Cardiomyopathy, Hypertrophic/complications ; Female ; Humans ; Hypertension/complications ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/pathology ; Hypertrophy, Left Ventricular/physiopathology ; Male ; Sex Factors ; Ventricular Pressure
Language	English
Publishing date	1995
Publishing country	Switzerland
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
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