Prognostic value of tissue Doppler echocardiographic imaging in elderly patients with acute myocardial infarction.

BACKGROUND: The ratio of mitral end-diastolic velocity and mitral annular early diastolic motion velocity (E/e') has predictive value in patients with acute coronary syndromes (ACS). Both E and e' velocities change with age. The prognostic value of E/e' in elderly patients with ACS has not been established yet. The aim of the study was to assess the prognostic significance of E/e' in patients over 65 with ACS. METHOD: The study involved 168 patients, mean age 79 years. Echocardiography was performed within first 24 hours of ACS. Clinical evaluation, 6-minute walk test, echocardiography and plasma level of NT pro-BNP were performed 12 months later. RESULTS: Patients, who were still alive after 1-year follow-up had significantly lower E/e' during hospitalization: 11.1 ± 3 versus 15.1 ± 5 (P < 0.05). The optimal cutoff value of E/e' differentiating survivors and nonsurvivors after 12 month follow-up was 12. Initial E/e' was an independent predictor of mortality during 1-year follow-up. E/e' ratio during hospitalization significantly correlated with NT pro-BNP concentration (r = 0.48, P < 0.001) and 6-minute walking distance: (r =-0.32, P < 0.05) after 1-year follow-up. CONCLUSIONS: (1) In patients over 65 with myocardial infarction, E/e' above 12 is an independent predictor of death during 1-year follow-up. (2) E/e' ratio in acute phase of myocardial infarction correlated significantly with N pro-BNP level and 6-minute walking distance after 1-year follow-up.

[Non-compaction of the left ventricle - not only in children]. / Kardiomiopatia gabczasta - nie tylko u dzieci.

A case of a 44-year-old woman with left ventricular non-compaction which manifested in adulthood as dyspnea, fatique and NYHA class III heart failure, is described. She received treatment typical for heart failure and was offered heart transplantation and cardioverter-defibrillator implantation which she refused. Unfortunately, she died suddenly three months after the diagnosis was established.

[Aortic aneurysym dissection in 80-year-old woman]. / Tetniak rozwarstwiajacy aorty wstepujacej u 80-letniej kobiety.

We present a case of 80-year-old woman with a history of paroxysmal atrial fibrillation admitted to the cardiology department due to syncope and chest pain with suspicion of pulmonary embolism. In course of further diagnostics the initial diagnosis was excluded and anticoagulant treatment was stopped. The real cause of the above signs and symptoms was aortic dissection. It was diagnosed by echocardiography and confirmed by CT scan. Patient was immediately transferred to the cardiosurgery department and successfully operated. The patient was discharged after 33 days in good condition.

Prognostic value of the N-terminal pro-B-type natriuretic peptide in the elderly with acute myocardial infarction.

BACKGROUND: Recent years have witnessed the increasing role of NT-proBNP as a prognostic tool in acute coronary syndrome (ACS). AIM: To evaluate prognosis of patients over 65 years of age with acute myocardial infarction (MI), based on NT-proBNP levels measured in the acute phase of MI. METHODS: The study involved 161 patients aged 79+/-8 hospitalised with acute MI, either with or without ST segment elevation (STEMI/NSTEMI). The NT-proBNP levels in serum were measured and echocardiography with left ventricular ejection fraction (LVEF) was performed in all patients upon admission to hospital. These tests were repeated after six months with the patients additionally subjected to the 6-minute walk test (6MWT). RESULTS: The average NT-proBNP level in the studied patients at admission to hospital was 7058+/-9649 pg/ml and increased in proportion to the age of patients. The NT-proBNP level did not differ significantly in STEMI and NSTEMI patients. Fifty-three patients died during the 6-month follow-up period. Their NT-proBNP levels at admission were significantly higher than in patients who were alive at the end of follow-up: 12237+/-13035 pg/ml compared with 4606+/-6214 pg/ml (p=0.0001). The NT-proBNP level upon admission to hospital proved to be an independent predictor of death in the six-month period following MI. Six months after MI the average left ventricular ejection fraction in the studied group of patients was 49+/-10% and the average distance in the 6MWT was 361+/-151 m. There was a significant negative correlation between these two parameters and the initial NT-proBNP level determined upon admission to hospital. CONCLUSIONS: An increased NT-pro-BNP level, measured in the acute phase of MI, is a significant prognostic factor during six-month follow-up after MI in patients aged over 65.

[Thrombus entrapped in the foramen ovale in an 80-year-old woman with chronic pulmonary embolism manifested by recurrent syncope--a case report]. / Skrzeplina wklinowana w otwór owalny u 80-letniej chorej z przewlekla zatorowoscia plucna manifestujaca sie nawracajacymi omdleniami.

We present a case of an 80-year-old female admitted to hospital because of recurrent syncope. The echocardiogram revealed a large thrombus in the left and right atria, entrapped in the patent foramen ovale, right heart enlargement and pulmonary hypertension. Magnetic resonance confirmed significant pulmonary embolism. The patient was successfully treated with fractioned heparin.

Angiotensin II AT1 receptor density on blood platelets predicts early left ventricular remodelling in non-reperfused acute myocardial infarction in humans.

BACKGROUND: Renin-angiotensin-system activity, a principal factor determining ventricular remodelling after myocardial infarction (MI), is dependent on local angiotensin II concentration and angiotensin AT1 receptor (AT1R) density. The latter is regulated by systemic factors acting independently from angiotensin II concentration. OBJECTIVE: To test the hypothesis that AT1R density at the onset of MI determines post-MI ventricular remodelling. METHODS: In 48 patients with first acute MI who did not undergo reperfusion therapy, angiotensin AT1R density on blood platelets (reflecting cardiovascular AT1R density) was assessed 13+/-5 h after the onset of MI, using radioligand binding assay. Left ventricular end-systolic (LVESVI) and end-diastolic volume indices (LVEDVI) and ejection fraction (EF) were assessed by two-dimensional echocardiography as measures of ventricular remodelling. RESULTS: Predischarge LVESVI and LVEDVI positively and EF negatively correlated with AT1R density. Patients with AT1R density below median had significantly lower LVESVI (33.2+/-2.4 mL/m2), LVEDVI (70.0+/-2.8 mL/m2) and higher EF (52.8+/-2.3%) than patients with AT1R density above median (LVESVI = 44.9+/-2.6, LVEDVI = 81.3+/-3.9 mL/m2 and EF = 44.9+/-2.6%, all p<0.01). In multivariate analysis, only AT1R density and infarct size were independent predictors of early post-MI ventricular dilation. CONCLUSIONS: High density of AT1R at the onset of MI is a predictor of early left ventricular remodelling.

[Surgical treatment of interventricular septum rupture in an 87-year-old female with acute antero-lateral myocardial infarction and 97% risk according to the Euroscore scale]. / Pekniecie przegrody miedzykomorowej u 87-letniej chorej ze swiezym zawalem sciany przednio-bocznej skutecznie leczone operacyjnie. Czy 97% ryzyko wg skali Euroscore jest przeciwwskazaniem do operacji?

Rupture of the interventricular septum is a serious complication of myocardial infraction (MI). It occurs in 1-3% of all MI cases, usually within 2 weeks after infraction. In 60% of the cases post-MI ventricular septal defects (VSD) are the result of completely occluded coronary artery supplying anterior wall of left ventricle and subsequent transmural MI. 50% of patients die within the first week after the rupture unless they are surgically treated. In this case report we describe an 87-year-old woman with post-MI VSD who was successfully operated (endocardial patch exclusion technique, proposed by David). In spite of a very high predicted risk (97% by Euroscore), calculated high risk should not be considered as the contraindication for life-saving operation.

[Renal carcinoma extending to the inferior vena cava and the right atrium. A case report]. / Przerzutowy guz raka nerki imitujacy sluzaka prawego przedsionka. Opis przypadku.

A case of a 66-year-old male hospitalised due to heart failure is presented. Echocardiography showed an abnormal structure in the right atrium resembling myxoma or thrombus. Abdominal ultrasonography revealed a right renal tumor. Finally, magnetic resonance imaging showed that the abnormal structure in the right atrium was a neoplasmatic plug continuously extending from renal carcinoma. The renal tumor and it's metastatic plug were successfully removed during surgery.

Late ventricular remodeling in non-reperfused acute myocardial infarction in humans is predicted by angiotensin II type 1 receptor density on blood platelets.

BACKGROUND: Ventricular remodeling after myocardial infarction (MI) is largely dependent on renin-angiotensin system activity, which is determined by angiotensin II concentration and angiotensin II type 1 receptor (AT(1)R) density in target tissues. We have recently shown that AT(1)R density in the acute phase of MI determines post-MI ventricular remodeling at discharge (8 days). The aim of this study was to test whether this correlation is retained in a longer follow-up (6 months), in the same group of patients. METHODS: In 48 patients with first acute MI who did not undergo reperfusion therapy, angiotensin AT(1)R density on blood platelets (a presumable marker of cardiovascular AT(1)R density) was assessed 13+/-5 h after the onset of MI, using radioligand binding assay. Echocardiographic indices of left ventricular function and dimensions were used as measures of ventricular remodeling. RESULTS: 6 months after the infarction patients who at baseline had AT(1)R density above median (N=17) as compared to those with AT(1)R density below median (N=20) had higher left ventricular end-systolic volume index (LVESVI, 41.3+/-2.7 vs. 33.2+/-2.3) and lower ejection fraction (LVEF 48.1+/-1.8 vs. 54.7+/-2.0). Moreover LVESVI positively and LVEF negatively correlated with AT(1)R density although the strength of these correlations was weaker than at discharge. Infarct size as reflected by a single troponin T measurement and post-MI therapy did not differ between high- and low-AT(1)R groups: over 85% patients received ACE-inhibitor, beta-blocker and statin. CONCLUSIONS: High AT(1)R density on blood platelets (a presumable marker of cardiovascular AT(1)R density) drawn in the acute phase of MI predicts poorer left ventricular systolic function in 6-month follow up. This suggests that modern therapy offers suboptimal blockade of renin-angiotensin system activity in the setting of MI.