Electrocardiographic appearance of aortic stenosis before and after aortic valve replacement.

BACKGROUND: So far, the specific appearance of QRS complex, ST-segment, and T wave was observed in aortic stenosis (AS). S-wave dynamic change in leads V1 -V3 was not reported in AS. METHODS: In a single-center, prospective study, we included a total number of 1.175 patients who underwent surgical aortic valve replacement (AVR). We conducted 3-year gathering of patients with symptomatic and asymptomatic severe AS, and separated them by hemodynamic stability into groups A and B, through EFLV (of more or less than 50%), AVA (of more or less than 0.9 cm2 ), PG (between 55 and 75 mm Hg or over 75 mm Hg), and end-diastolic LV dimension (of more or less than 56 mm). We evaluated the impact of S-wave magnitude in right precordial leads before and after AVR in all patients. We followed S-wave changes in electrocardiogram altogether with hemodynamic measurements derived from echocardiography. RESULTS: Analysis of echocardiographic parameters, measured in patients before surgery, did not show statistical significance between asymptomatic and symptomatic group. The statistical significance was observed in the change in S-wave magnitude in the right precordial leads in both subsets of patients before AVR. We found statistically significant predictive value of S-wave magnitude in leads V2 -V3 for dependent variables PG and end-diastolic LV dimension. CONCLUSIONS: S-wave changes in right precordial leads can predict increase in PG and critical narrowing of AVA, suggestive of timely referral for AVR.

Adenosine cardioprotection study in clinical setting of paroxysmal supraventricular tachycardia.

PSVT attack of >20min and frequency >160 is well-recognized model of myocardial dysfunction. We measured 6-keto-PGF1alpha and TXB(2) before and after adenosine administration to assess its cardioprotective potential. A total of 64 patients were randomly assigned as having acute episode of PSVT to adenosine or verapamil group. A bolus of 6mg of adenosine up to the maximum dose of 12 or 5mg of verapamil up to the maximum dose of 10mg were given, until the sinus rhythm was restored. The levels of PGI(2), TXA(2) and TAS were measured in three different time intervals. In adenosine group all parameters were normalized after 20min of conversion to sinus rhythm. The ratio of PGI(2)/TXA(2) increased after 5min of conversion to SR (P<0.01). Also, the ratio of TXA(2)/TAS was decreased for ADO (P<0.01). This is the first study to demonstrate that adenosine exerts cardioprotective effect.