Facilitated PCI in patients with ST-elevation myocardial infarction.

BACKGROUND: We hypothesized that percutaneous coronary intervention (PCI) preceded by early treatment with abciximab plus half-dose reteplase (combination-facilitated PCI) or with abciximab alone (abciximab-facilitated PCI) would improve outcomes in patients with acute ST-segment elevation myocardial infarction, as compared with abciximab administered immediately before the procedure (primary PCI). METHODS: In this international, double-blind, placebo-controlled study, we randomly assigned patients with ST-segment elevation myocardial infarction who presented 6 hours or less after the onset of symptoms to receive combination-facilitated PCI, abciximab-facilitated PCI, or primary PCI. All patients received unfractionated heparin or enoxaparin before PCI and a 12-hour infusion of abciximab after PCI. The primary end point was the composite of death from all causes, ventricular fibrillation occurring more than 48 hours after randomization, cardiogenic shock, and congestive heart failure during the first 90 days after randomization. RESULTS: A total of 2452 patients were randomly assigned to a treatment group. Significantly more patients had early ST-segment resolution with combination-facilitated PCI (43.9%) than with abciximab-facilitated PCI (33.1%) or primary PCI (31.0%; P=0.01 and P=0.003, respectively). The primary end point occurred in 9.8%, 10.5%, and 10.7% of the patients in the combination-facilitated PCI group, abciximab-facilitated PCI group, and primary-PCI group, respectively (P=0.55); 90-day mortality rates were 5.2%, 5.5%, and 4.5%, respectively (P=0.49). CONCLUSIONS: Neither facilitation of PCI with reteplase plus abciximab nor facilitation with abciximab alone significantly improved the clinical outcomes, as compared with abciximab given at the time of PCI, in patients with ST-segment elevation myocardial infarction. (ClinicalTrials.gov number, NCT00046228 [ClinicalTrials.gov].)

[Erectile dysfunction, and risk factors of cardiovascular disease]. / Zaburzenia erekcji a czynniki ryzyka choroby sercowo-naczyniowej.

The paper is a review of the reports presenting the essential aspects of erectile dysfunctions being a serious challenge for the clinicians of various specializations because of increasing number of the diagnosed cases of sexual impairments caused by atherosclerotic background. The authors present the results of the most crucial studies concerning epidemiology of the said condition, an effect of the various demographic factors on its occurrence, with the focus laid on the significant correlation between classic risk factors of atherosclerotic cardiovascular disease and reasons leading to erectile dysfunctions. The work presents also the diagnostic and therapeutic obstacles, the physicians struggling with this more and more often disease, encounter in their every day practice.

[Physical activity in basic and primary prevention of cardiovascular disease]. / Aktywnosc fizyczna w podstawowej i pierwotnej prewencji choroby sercowo-naczyniowej.

On account of the frequency of appearing and character of atherosclerosis cardiac vascular disease, one of the most crucial elements of effective fight against it is preparation of complex preventive programs including as vast number of population as possible. Consequently, Benjamin and Smitch suggested attaching the notion of basic prevention to the standard division into primary and secondary one. The basic prevention, carrying out in the general population, should concern genetic predisposition, psychosocial factors, keeping up proper body weight, healthy eating and physical activity. Especially high hopes are connected with high efficiency, simplicity and low money-consumption of preventive activities associated with physical activity modification, which has a crucial influence on reducing negative impact of atherosclerosis hazard. The results of numerous scientific research, carried out in many countries and on various, large groups, proved undoubtedly that at the healthy adult people of both sex the systematic physical activity of moderate intensification plays an essential part in preventing CVD and decreasing the death risk because of that reason as well. Moreover, systematic physical exercises show many other health-oriented actions, thanks to which they have an influence on decreasing premature and total death rate. The risk of incidence of civilization-related diseases such as diabetes type II, hypertension, obesity, osteoporosis, tumors (of large intestine, breast, prostatic gland) and depression has decreased significantly. Unequivocally positive influence has been proved at many observations dedicated to health recreational physical activity and physical activity connected with professional work based on aerobe effort. The positive effects have been also observed at children population and senior population which is more and more numerous and the most at risk. The beneficial action of physical activity is connected with direct effect on organism, which leads to adaptive changes increasing the efficiency of its functioning and, in intermediate way, modifying and reducing the influence of other risk factors of cardiac vascular disease, mainly obesity dyslipidemy and hypertension. The subsequent scientific observations had an influence on the alterations of scientific associations recommendations concerning the preferred kind, intensity and effective dose of health-oriented physical activity. The current recommendations on preventive usefulness of physical activity, implemented by Polish Cardiological Association, have been based on a document containing the guidelines of European Cardiologic Association coming from 2003. All described evidences present in unambiguous way the undeniable benefits of active lifestyle. Its promoting as well as supporting in this area vast number of population, especially in case of disturbing epidemiological data, is becoming a duty of not only health service workers but also state administration employees responsible for planning public health expenditure.

[Complex cardiac rehabilitation in a strategy of secondary prevention of cardiovascular disease]. / Kompleksowa rehabilitacja kardiologiczna w strategii prewencji wtórnej choroby sercowo-naczyniowej.

Due to the frequency of occurrence of cardiovascular disease and its course full of severe complications, patients with this condition make a special population. This group is the addressee of the preventive actions included in secondary prevention. The goal of these actions is a reduction of frequency of the occurrence of consecutive incidents connected with ischemic heart disease, ischemic stroke and peripheral artery disease. The actions put a special emphasis on the counteraction of significant and negative from the social-economic point of view phenomenon, such as disability and premature deaths. The key role within the frames of the integrated preventive procedure in the patients with cardiovascular disease plays the modification of physical activity, mainly realized as a part of a supervised physical training. The training is a basic element of a systematized cardiac rehabilitation. It was Hellerstain, who as a pioneer in using this kind of rehabilitation in the patients after acute coronary incidents, and in the 1950s began propagating a multi-disciplinary attitude to the cardiac rehabilitation programs. Since WHO's formulation of the first definition of cardiac rehabilitation in 1964, as a result of the achievements of modern invasive cardiology, cardiosurgery and pharmacotherapy, the procedures of treatment of the patients with acute coronary syndrome changed radically. Moreover, a time of their hospitalization has shortened significantly. This fact had an influence on created by many scientific associations the successive development of the standardized process of convalescence, which is cardiac rehabilitation. The Board of Polish Society of Cardiology (PTK), appreciating the rank of the issue, appointed a group of experts to work on the standards of the cardiac rehabilitation, which were published in 2004 in the journal "Folia Cardiologica". Based on the modified in 2003 requirements established by The Working Group of Rehabilitation and Effort Physiology of European Society of Cardiology and the authors' own experiences, they standardize the regulations of the cardiac rehabilitation. What is specially underlined in this document is keeping the regulation of cardiac rehabilitation effects optimization with maximum safety for the patients and recommending wide, not depending on age, access to complex rehabilitation programs, which contains multi-factor interventive actions. Promoting all aspects of the improvement of physical activity, the cardiac rehabilitation programs contribute to the large extent to the positive modification of arthrosclerosis risk factors, the improvement of physical performance and reducing the risk of occurrence of next acute cardiovascular incidences. All the above-mentioned aspects lead to a comeback to active participation in the social life, and consequently have a positive influence on the quality of life of the people with cardiovascular disease. The aim of this work is summing up the present knowledge of cardiac rehabilitation as a basic element of secondary prevention.

[Evaluation of ambulatory cardiac rehabilitation influence on the intensity of erectile dysfunction in patients with ischemic heart disease]. / Ocena wplywu ambulatoryjnej rehabilitacji kardiologicznej na natezenie zaburzen erekcji u chorych na chorobe niedokrwienna serca.

UNLABELLED: Considering a progressive course of cardiovascular disease, often leading to premature death, and difficulty in obtaining long-lasting stabilization of clinic state, it is deeply justified to take preventive interventions completing repairing actions and pharmacotherapy. Addressing various preventive programs to the patients with CVD, we put a special emphasis to simple and low-cost modification of physical activity, which has a beneficial influence on the circulatory system. As it has been proved, protective action of physical activity on the vessels concerns the whole arterial system including the vessels responsible for erectile dysfunction (ED) creation. THE AIM OF THE STUDY: The analysis of the influence of physical activity modification, taking place within frames of a six-month supervised cardiac rehabilitation, on ED intensification in the population with ischemic heart disease (IHD). MATERIAL AND METHODS: The analysis has been conducted on 129 patients with IHD, whose preliminary test IIEF-5 (International Index of Erectile Function-5) showed < or =21 scores, which justified ED diagnosis. The analyzed group consisted of 98 patients with IHD at the mean age of 62.35 +/- 8.88 years, who were subjected to the six-month cardiologic rehabilitation. The testing group comprises 31 patients with IHD at the mean age of 61.71 +/- 7.35, who were not rehabilitated for objective reasons. The patients of both groups filled in an IIEF-5 questionnaire twice, at the interval of six months. RESULTS: As a result of cardiologic rehabilitation in the analyzed group, a statistically significant increase in scores occurred in the IIEF5 test, from 11.88 +/- 6.2 to 13.69 +/- 7.07, which was not observed in the control group. Moreover, a division of the analyzed group into ED intensity categories (severe, medium-severe, moderate, light) confirmed the occurrence of significant changes of ED intensity for subsequent ED severity categories. For the subsequent ED intensity categories, from the greatest to the lightest, the statistically significant increase of the scores from a sheet IIEF-5: 4.66 +/- 0.98 vs. 5.34 +/- 1.41 (p < 0.01); 9.5 +/- 1.2 vs. 10.9 +/- 1.58 (p < 0.01); 14.67 +/- 1.22 vs. 17.7 +/- 1.80 (p < 0.01) and 19.62 +/- 1.11 vs. 21.85 +/- 1.23 (p < 0.01) has been found. Bearing in mind the dependence of results on the credibility of data from the sheet IIEF-5, the last element was the analysis of 'truthfulness test', which has not shown any statistically significant differences obtained for first and next filling in the questionnaire. CONCLUSIONS: The performed analyses allowed drawing the conclusions. A six-month cardiac rehabilitation cycle led to a significant positive modification of erectile dysfunction intensity. The greatest positive ED modification occurred at the groups of the patients, in whom the erectile dysfunction intensity was the smallest.

[Erectile dysfunction vs. physical capacity and physical activity at invasive treated patients with ischemic heart disease]. / Zaburzenia erekcji a wydolnossc fizyczna i aktywnosc ruchowa leczonych inwazyjnie chorych na chorobe niedokrwienna serca.

UNLABELLED: The numerous researches proved a thesis of the connection between the erectile dysfunction (ED) and atherosclerosis risk factors. The special part among the risk factors plays the low physical activity, which, due to rapid development of civilization, makes a serious problem concerning mainly the well-developed countries. THE AIM OF THE STUDY: Bearing in mind the fact of the physical activity influence on physical capacity and ED intensity, was an analysis of ED intensity in the population of patients with ischemic heart disease (IHD) and the evaluation of the relations connecting quality of erection with physical activity and physical capacity. MATERIAL AND METHODS: The analysis concerned 207 men with IHD at the age of 61-71 years (the mean: 66.77 +/- 2.63 years), treated invasively (163--PTCA, 44--CABG). All the men were professionally inactive for 3.23 +/- 2.12 years. All of them were in the relationships with the same partner for many years. The inclusion criteria were: a correctly filled questionnaire IIEF-5 (all categories), a Framingham questionnaire and ECG treadmill test assessed as a negative one. RESULTS: The erectile dysfunction was recognized when in the questionnaire IIEF-5 the total number of points was < or =21. A parameter of an exercise test subjected to evaluation was the value of metabolic equivalent (MET) and analyzed parameter from the Framingham questionnaire was activity intensity in free from work time (MET/h). In the analyzed group of 207 patients with IHD, the erectile dysfunction showed 71.5% of the population. The average value obtained for the examined IHD patients from the IIEF-5 questionnaire was 14.05 +/- 7.40. Taking into account the number of obtained in the questionnaire points, the patients with ED were divided into four categories: severe--29.5% of the whole group, medium-severe--8.2% of population, medium--20.8% of population and moderate--13% of the IHD population. The effort test and the analysis of Framingham questionnaire revealed information about physical capacity and physical activity of particular patients with IHD. The analysis of dependence between physical capacity and quality of erection conducted for the group of patients with IHD showed the lack of statistically significant correlation between these parameters (Pearson's correlation coefficient r = 0.013). The analysis of dependence between physical activity and quality of erection showed statistically significant correlation between these parameters (Pearson's correlation coefficient r = 0.781). Considering the dependence of results on the credibility of data from the IIEF-5 chart, the last element was the analysis of 'truthfulness test', which did not show any statistically significant difference between the results from the first and the next questionnaire. CONCLUSIONS: High everyday physical activity is significantly connected with the decreasing erectile dysfunction intensity and its evaluation may be a simple method allowing preliminary qualification of the patient to the group being at higher risk. The physical capacity presented by the patients with IHD is not significantly associated with quality of erection.

[Physical activity in prevention of cardiovascular disease]. / Aktywnosc fizyczna w prewencji choroby sercowo-naczyniowej.

The paper outlines an evolution of the physical activity profile of human being, determined by the natural environment conditions, as well by the dynamic progress in technology civilization. It was also emphasized how important role in spreading an epidemics of atherosclerosis--plays a reduced physical activity in people living in highly developed countries. Furthermore, the mechanisms of profitable effects of a regular physical training both for primary prevention of cardiovascular disease and for cardiac rehabilitation were discussed. In this regard, difficulties in realizing rehabilitation programs in patients with previous ACS episodes in Poland were highlighted. Finally, a necessity of undertaking efforts intended for establishing physical activity as a routine every-day habit even in young children, resulting in reducing cardiovascular morbidity and mortality in the later life stages, was stated.

[Age and effects of long-term cardiac training in patients with ischemic heart disease]. / Wiek a efekty dlugoterminowego treningu kardiologicznego u pacjentów z choroba niedokrwienna serca.

UNLABELLED: Ongoing with age decline of physical capacity reflects permanent processes of aging occurring in organism. It leads to a successive reduction of physical activity level, resulting with time in restrictions of independent life ability, which then causes anxiety and progressing social isolation. THE AIM: Evaluation of relation between age and effort tolerance in patients with chronic ischemic heart disease and comparison of cardiac rehabilitation effects in two patient groups at significantly various age. MATERIAL AND METHOD: The study comprised 103 patients (69 males and 34 females) at the mean age of 61.2 +/- 0,8 years. The patients were referred to rehabilitation because of undergone invasive treatment of IHD, using CABG (44 pts) and PTCA (48 pts), or acute coronary syndromes (11 pts). The study group was divided to the two subgroups, "A" and "B", differing significantly (p < 0.01) from each other by age. "A" group was constituted by 30 the youngest patients, with the mean age of 51.6 +/- 0.5 yrs, whereas "B" group comprised 30 the oldest patients, with the mean age of 70.9 +/- 0.6 yrs. The examined groups were comparable as to the drug treatment, clinical status, echocardiographic parameters and BMI values. During the observation period no changes in treatment and diet were made. The all patients were subjected to six-month cardiac rehabilitation, consisting of cycle ergometer training (3 times/week) and generally improving exercises (2 times/week). The parameters analyzed were the values of metabolic equivalent (MET) obtained at the initial and the final exercise treadmill test, likewise the delta of MET. RESULTS: For a population of 103 patients with IHD, the negative, statistically significant correlation Pearson's coefficient between age and MET values of initial and final exercise tests and insignificant Pearson's coefficient between age and values of MET delta were obtained. Comparison analysis of the mean MET of initial and final exercise test and the mean MET delta did not show any significant differences between the both examined "A" (young) and "B" (old) groups. CONCLUSIONS: In the examined patients with IHD, there were observed a negative, significant correlation between age and effort tolerance before and after the cardiac rehabilitation cycle, and a lack of significant correlation between age and delta of effort tolerance. There was found no considerable difference concerning a delta of effort tolerance between the patients with IHD falling into the young and the old groups.

[Hypotensive effect of 6-months cardiac rehabilitation in elderly patients]. / Efekt hipotensyjny szesciomiesiecznej rehabilitacji kardiologicznej u chorych w podeszlym wieku.

UNLABELLED: Both effective treatment of arterial hypertension and prevention from its complications are considered very important issues, especially in a population of elderly people, in whom hypertension occurs along with other risk factors, resulting in increase of incidence of myocardial infarction and stroke. THE AIM: There were assessed an influence of 6-month ambulatory cardiac rehabilitation on level of resting and peak systolic and diastolic arterial pressure in elderly patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH), likewise relations between the pressure alterations and the age of the examined patients. MATERIAL AND METHOD: A group of 70 patients with IHD and AH treated invasively was subjected to a rehabilitation program. Group A consisted of 37 patients with the mean age of 69.0 +/- 0.5 years, and group B of 33 patients with the mean age of 51.5 +/- 0.5 years. The patients from the both groups differed significantly only as to the age, whereas they were comparable regarding current clinical status, echocardiographical parameters, BMI values and applied pharmacological treatment. During a follow-up period, neither drug regimen, established at least three months earlier, nor a diet were not modified. The all patients underwent a 6-month cardiac rehabilitation, combining exercises on cycle ergometers (3 times per week) and generally improving training (2 times per week). There were analyzed: the mean values of resting and of peak systolic and diastolic blood pressure at the beginning of the rehabilitation and upon completion of the program. RESULTS: Comparison of the patients from groups A and B did not reveal any significant differences concerning the initial mean values of both resting and peak pressure (systolic and diastolic). Just after the rehabilitation finishing, in A group, a statistically significant reduction of resting systolic and diastolic pressure, likewise insignificant reduction of peak systolic and diastolic pressure were observed. Contrarily, in B group, it was noted a significant reduction of resting systolic and diastolic pressure and insignificant reduction of peak diastolic pressure. In this group, yet, an insignificant increase of peak systolic pressure was found. In the both groups, there was no statistically significant correlation between the age and the delta values of resting and peak systolic and diastolic pressure. CONCLUSION: Long-term ambulatory cardiac rehabilitation caused a profitable blood pressure lowering in patients with IHD and AH, regardless of the age. A changes intensity of resting and of peak blood pressure did not show a dependence on the patients' age.

[Effect of long-term cardiac training on lipids concentration in patients with chronic heart ischemic disease treated with simvastatin]. / Wplyw dlugotrwalego treningu kardiologicznego na stezenie lipidów u chorych z przewlekla choroba niedokrwienna serca leczonych simwastatyna.

UNLABELLED: Dyslipidemia worsens a prognosis in patients with chronic heart ischemic disease, who underwent myocardial infarction. Therefore, new methods, besides drugs, are being sought, for optimizing a serum concentration of lipid fractions. THE AIM: An effect of 6-month of ambulatory long-term cardiac rehabilitation on the lipidogram fractions concentration in patients with chronic heart ischemic disease treated with simvastatin, as well as a correlation between lipids changes and cardiac training intensity was assessed. MATERIAL AND METHOD: Rehabilitation was performed in 66 patients with previous myocardial infarction treated invasively (27 CABG and 39 PTCA), who constituted group I. A control group (group II) consisted of 32 patients with previous myocardial infarction also treated invasively (24 CABG and 8 PTCA), but not subjected to rehabilitation. The two analyzed groups did not differ significantly from each other as to age, applied drug regimen, current clinical status, echocardiographic parameters and BMI values. Group I was subjected to 6-month cardiac rehabilitation program, comprising 45-minute training on cycle ergometer (three times per week) and generally improving exercises (2 times per week). Blood concentration of lipidogram fractions was assessed: total cholesterol (TC), HDL- and LDL-cholesterol, and triglicerides (TG) at the onset and upon completion of the rehabilitation cycle. RESULTS: The both patient groups were comparable concerning the initial concentration of the lipid fractions. After finishing the rehabilitation program, in the group I, a statistically significant reduction of TC, LDL and TG concentration was found out. In addition, a significant increase of HDL concentration was noted. In contrary, in the group II (without rehabilitation), the only significant change concerned a concentration of HDL fraction, which decreased. Furthermore, in the group I, it was noted a negative, statistically significant correlation between intensity of cardiac training, expressed by training workload and delta of work, and a difference in blood concentration of triglicerides, measured just before the training onset and after the program was finished. CONCLUSION: It was revealed that long-term ambulatory cardiac rehabilitation has a profitable effect on serum concentration of the all lipid fractions in patients with chronic heart ischemic disease cured with simvastatin, regardless of training intensity. It was also ascertained that an extent of changes in triglicerides serum concentration was related to an intensity of the cardiac training applied to the patients.

[Effect of ambulatory supervised cardiac training on arterial hypertension in patients with coronary artery disease and arterial hypertension]. / Wplyw ambulatoryjnego kontrolowanego treningu kardiologicznego na cisnienie tetnicze u chorych na chorobe niedokrwienna serca i nadcisnienie tetnicze.

UNLABELLED: Arterial hypertension is one of the most common health problems occurring in highly developed countries. It was proved that long-term and regular physical activity results in hypotensive effect. THE AIM: A goal of the present study was to assess an influence of six-month ambulatory cardiac rehabilitation on arterial pressure level in patients with coronary artery disease and hypertension as well as analysis of correlation between pressure values alterations and intensity of cardiac training. MATERIAL AND METHODS: A study group comprised 103 patients (mean age: 61.2 +/- 0.8 years) manifesting coronary artery disease accompanied by arterial hypertension. A control group constituted 39 normotensive patients with coronary artery disease (mean age: 59.4 +/- 1.3 years). The both observed groups differ from each other only with values of left ventricle mass index and drug regimen established at least three months prior to the follow-up onset. During the rehabilitation cycle, no treatment corrections were made and no new preparations were added. The all patients were enrolled to the six-month cardiac rehabilitation program. The program comprised 45-minute training with cycle ergometer, three times a week, and generally improving gym exercises, two times a week. The analyses concerned systolic and diastolic pressure values, measured just before each training (resting pressure) and just after peak exercise interval (peak pressure), at the beginning and at the end of the rehabilitation cycle. At the initial stage, the patient group with hypertension demonstrated the higher pressure values (resting and peak), as compared with the control group. RESULTS: Cardiac rehabilitation performed in the examined patients caused a statistically significant reduction of the mean resting pressure, both systolic (p < 0.01) and diastolic (p < 0.01). As to the mean peak pressure in this group, systolic diminished slightly (NS), but diastolic was reduced significantly (p < 0.01). In the control group, after six-month rehabilitation the values appeared to be lowered insignificantly in relation to systolic and diastolic resting pressure, likewise diastolic peak pressure, and contrarily systolic peak pressure increased slightly. Assessing an interrelation between the final outcome of the rehabilitation program, expressed as delta of arterial pressure, and terminal training workload and delta of training workload, only for delta of systolic pressure and final training workload, a positive correlation of statistical significance was found out, which is considered an implication of physiological reaction against an increase of training workload. CONCLUSIONS: Long-term and regular cardiac training induced the larger alterations of pressure values in the patients with hypertension, as compared with the normotensive patients. A positive effect of cardiac rehabilitation on arterial pressure level in the hypertensive patients was found to be independent of the training intensity.

[Positive microvolt T-wave alternans as a marker of ventricular arrhythmia trigering during cardioverter-defibrillator implantation]. / Dodatni wynik badania mikrowoltowej naprzemiennosci zalamka T identyfikujacy chorych podatnych na wywolanie arytmii komorowej podczas wszczepiania kardiowertera-defibrylatora.

Microvolt T-wave alternans (MTWA) is promising method for noninvasive assessment of arrhythmic risk, but its role hasn't established yet. The aim of this study was to establish the MTWA potency to predict the ventricular arrhythmia triggering during implantable cordioverter-defibrillator (ICD) implantation. Material and metods. The study group consisted of 21 patients, aged 63.0+/-8.0 years; EF was 38.0+/-12.8%. Seventeen of them had a history of myocardial infarction and 4 had non-ischemic cardiomyopathy. The reason for ICD implantation were secondary prevention due to nonfatal cardiac arrest caused by VF/VT in nineteen patients and in two patients ICD was implanted because of unexplained syncope and low EF (< or =35%). All patients underwent VT/VF triggering during device implantation caused by electrophysiological study (EPS). If this proved ineffective aggressive protocol of 50 Hz BURST and T SHOCK was applied. After ICD implantation the following tests were performed: ECG with HR, QRS and QTc evaluation, 24-hour ECG Holter monitoring with HRV assessment and MTWA evaluation during treadmill exercise test. Results. In the group with VT/VF induced by less aggressive protocol (EPS), group I (n = 10) MTWA was present in nine patients, in one the result of MTWA was indeterminate. In the group with VT/VF induced by more aggressive protocol, group II (n = 11) MTWA was present in four patients, indeterminate in four and absent in three. There was a significant (p = 0.017) difference between group I and II in the frequency of positive result of MTWA. There were no differences between the two groups according to time domain parameters of HRV such as SDNN, RMSSD and PNN50 and QTc. There was a significant difference between the two groups in time duration of QRS complexes, 118.9+/-14.7 vs. 105.6+/-11.5 accordingly (p < 0.04). Conclusions. MTWA may help identify patients in whom VTNVF is more easily inducible by electrophysiologic study during ICD implantation. It is easier to induce ventricular arrhythmia when QRS complexes are wider, irrelevant to left ventricular dysfunction and autonomic function of the heart.

[The influence of myocardial infarction on depression in patients with coronary artery disease]. / Ocena wplywu przebytego zawalu miesnia sercowego na nasilenie depresji u chorych na chorobe niedokrwienna serca.

UNLABELLED: The recent studies revealed the relation between depression and the prevalence of cardio-vascular diseases, as well as their complications. However the correlation between the risk factors of coronary artery disease and depression in patients suffering from cardio-vascular disorders hasn't been sufficiently examined. The history of myocardial infarction (MI) is a well known factor, which increases mortality. The aim of the study was to determine if there was any relation between the history of myocardial infarction and depression rate in patients with cardio-vascular diseases. MATERIAL AND METHODS: The study involved 163 patients, 75 women and 88 men, aged 29 to 86 years (mean age 60.75 +/- 11.01), hospitalised for the purpose of undergoing coronary angiography or percutaneous transluminal coronary angioplasty (PTCA). Before the procedure, the symptoms of depression were evaluated in all the patients. Each of them filled the Beck's scale inquiry-sheet. Two groups of patients were detached: group A consisted of patients with the history of MI (n = 96), group B-of patients with negative history of MI, diabetes who had never undergone PCI, or coronary artery bypass graft (CABG) before (n = 42). The control group (group C) consisted of 75 individuals, aged 20 to 80 (mean age 45 +/- 11.14 y), who felt healthy according to WHO criteria, weren't on any medication, hadn't been hospitalised in previous 5 years (at any reason) and in whom cardio-vascular diseases and their modificable risk factors were excluded. RESULTS: The median of the Beck's score of depression for group A (9 points) was significantly higher (Wilcoxon test), than for group B (6.5 points), p < 0.02 and for the group C (3 points), p < 0.05. (tab. 1). CONCLUSIONS: In patients with cardio-vascular disorders depression is more frequent, than in health individuals. History of MI increases the prevalence of depression.

[Severity of coronary artery disease in patients with acute coronary syndrome without ST segment elevation]. / Stopien zaawansowania choroby wiencowej u pacjentów z ostrym zespolem wienicowym bez uniesienia odcinka ST.

Risk stratification of patients presenting to the hospital with acute coronary syndrome (ACS) is usually based on ECG assessment, and several clinical and biochemical criteria, which are all intended to identify subjects with more severe disease, who might benefit from aggressive medical or interventional treatment. However, no one widely accepted jeopardy score is available. Our aim was to determine whether the initial ECG, biochemical data and past medical history correlate with the extent of coronary artery disease in patients with ACS thus identifying subjects with severe coronary artery disease (CAD) who may benefit from the early invasive strategy. Patients' data was prospectively collected and retrospectively analysed according to the result of angiography examination. Our cohort consisted of 220 consecutive patients hospitalised due to typical chest pain (> 5 min.) occurring at rest within the last 24 hours. Study group comprised of 115 patients, who were subsequently subjected to coronary angiography Blood for qualitative troponin I test (Cardiac STATus, Spectral Inc., NJ, USA), and other routine biochemistry tests was drawn and ECG was done on admission. Chi-square and Pearson correlation tests were used for statistical analysis, p < 0.05 being considered statistically significant. Stepwise forward regression analysis was used to identify variables predictive of significant coronary artery stenosis. We have identified 65 patients with significant and 5 patients with insignificant multivessel stenosis, 33 patients with significant and 7 patients with insignificant single vessel disease. Five patients had normal coronary arteries. Male sex was significantly more prevalent among patients with coronary artery disease than with normal arteries (71% vs. 40%, p = 0.02). No differences in biochemistry values were seen among the groups. There was a significant difference in the prevalence in ST segment depression (p = 0.03) among these patients and in the incidence of plasma fibrinogen levels of >380 mg% (p = 0.02), those findings being most frequently encountered in significant multi- and single-vessel disease subjects. Hypertension, myocardial infarction more than 10 days ago, history of smoking, hypercholesterolemia and diabetes were independent predictors of the presence of significant stenosis. Assessment of admitting ECG and troponin I together with patients medical history may allow for identification of ACS patients with significant CAD that may benefit from early invasive treatment.

[Troponin I levels after uncomplicated, elective percutaneous coronary intervention in patients with stable coronary heart disease]. / Stezenia troponin po niepowiklanych zabiegach planowanej angioplastyki wiencowej u chorych ze stabilna choroba wiencowa.

UNLABELLED: Percutaneous coronary intervention is a proven method of treatment of significant number of patients with coronary artery disease. Sometimes it is accompanied by increases of troponin levels. Frequency and degree of these phenomena are not well known. THE AIM: of the present study was to establish frequency and a degree of the increase of cardiac troponin I (cTnI) in patients with stable coronary artery disease who underwent elective PTCA without complications during hospitalization. MATERIAL AND METHODS: Our study included 99 patients fulfilling the above mentioned criteria. Average patients' age was 58,7 years (range 37-82 years). In 67 patients PTCA was performed on one artery, in 27 on two and in five on 3 arteries. In 36 patients standard stents were implanted, in the remaining (63 patients) only PTCA was performed. In the group with stents 29 patients had 1 stent implanted, 6 patients had 2 stents and one had 3 stents implanted. In all the patients cTnI (Abbott AxSYM Immunoassay) were determined before PTCA, 12 and 24 hours after PTCA. RESULTS: After 12 hours percentage of cTnI results above 1.22 microg/L (cut-point for spontaneous infarction according to the new definition of heart infarction) amounted to 35% and above 2.0 microg/L (cut-off according WHO infarction definition) 28%. After 24 hours the percentages were similar. Typical cTnI results (90%) after PTCA were below 10 microg/L. cTnI levels were weakly but statistically significantly correlated with number of vessels, which underwent PTCA. CONCLUSION: Moderate increases in troponin I after PTCA seem to correspond to minimal, in general, cardiac injury.

Effect of Endurance Cardiovascular Training Intensity on Erectile Dysfunction Severity in Men With Ischemic Heart Disease.

The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.

Plasma fibrinogen and troponin I in acute coronary syndrome and stable angina.

We aimed to determine whether there is a stratification among patients with different stages of coronary artery disease with respect to plasma fibrinogen levels, and to assess diagnostic value of plasma fibrinogen in comparison to troponin I in patients with acute coronary syndrome. Fifty-one consecutive patients presenting to our department with acute coronary syndrome within the last 24 h and 52 patients with stable angina with no episode of unstable disease within the last month were analysed. Forty-nine patients with acute coronary syndrome in which both troponin I and fibrinogen levels were present were further evaluated. Blood was collected on admission for routine laboratory tests. Statistical analysis was done using Student's t-test, Pearson correlation and chi-square test, P<0.05 being considered statistically significant. Plasma fibrinogen levels (g/l) were significantly higher in patients presenting with unstable than with stable angina (3.87+/-1.2 vs. 3.26+/-0.65 P=0.002). We have found significant correlation between fibrinogen and troponin I levels in unstable patients (r=0.43, P=0.0015). In patients with acute coronary syndrome an increased inflammation and cardiac injury seem to coexist and correlate. These results seem to confirm the role of this acute phase protein in the pathophysiology of acute coronary syndrome.

PRimary coronary angioplasty versus thrombolytic therapy. Comparison of mortality in the acute phase of myocardial infarction - a single centre experience.

BACKGROUND: Patency of an infarct-related artery may be achieved by the use of primary coronary angioplasty or thrombolysis. In spite of the growing number of reports dealing with this topic, controversies exist as to the superiority of either of these therapeutic options. Moreover, the role of primary angioplasty has not yet been clearly defined in the guidelines of the Polish Cardiac Society. AIM: To compare mortality in the acute phase of myocardial infarction (MI) in patients treated with primary angioplasty versus patients receiving thrombolytic treatment. METHODS: Using prospectively collected data from all consecutive patients with acute MI admitted to our institution, we analysed retrospectively mortality in patients treated with primary angioplasty versus those who received thrombolysis. RESULTS: Between May 1996 and October 2000, 657 patients with acute MI were hospitalised. Of this group, in 66 (10%) patients primary angioplasty was performed, and 278 (42.3%) received thrombolysis. Cardiogenic shock complicated MI in 20 (30%) patients treated with angioplasty and in 19 (7%) thrombolysed patients. Total mortality in the acute phase of MI was 12 (18.2%) patients in the angioplasty group versus 26 (9.4%) patients in the medically treated group (p<0.05). Mortality among patients with cardiogenic shock was significantly higher in those who received thrombolysis than in those who underwent angioplasty [17 (89.5%) patients versus 11 (55%) patients (p<0.05)] and tended to be higher among patients without cardiogenic shock [9 (3%) thrombolysed patients versus 1 (2.2%) patient who underwent angioplasty, NS]. CONCLUSIONS: Primary coronary angioplasty improves the outcome in patients with acute MI complicated by cardiogenic shock and tends to decrease mortality among patients without cardiogenic shock.

[Knowledge of coronary heart disease risk factors among students of Warsaw universities]. / Znajomosc czynników ryzyka choroby wiencowej wsród studentów wyzszych uczelni warszawskich.

Prevention of coronary heart disease (CHD) is the most effective way in fighting with epidemic of this illness in our country. Risk factors of CHD are divided into modifying and non-modifying. General knowledge of cardiac risk factors in young population is the most important point in prophylactic. Our aim was to elucidate knowledge of cardiovascular disease risk factors in students. We distributed a questionnaire to 544 students (264 women and 280 men) of 3 Universities in Warsaw in the middle age 22 +/- 0.79. The survey contained 22 answers: general risk factors (obesity--O, high cholesterol level--Ch, smoking--S. hypertension--HA, wrong diet--D, family history--F, life style--S, age--A, diabetes--DM, male--M, down limbs arteriosclerosis--DLA, myocardial infarction in family under 55 years old-MI) and wrong answers (allergic, female, mobile phone...). Data were taken under analyze. Right risk factors were mentioned by the following number of students: O--92%, Ch--89%, S--85%, HA--75.8%, D--71%, F--65.2%, DM--50.4%, M--49.3%. DLA--36.9%, MI--36.0%. General knowledge of modifying cardiac risk factors, not including diabetes, is high among polish students. However, the knowledge is poor about non-modifying factors, like gender, age, early MI in family. The results of our study let us hope that the students will correctly use their knowledge to reduce risk of CHD in their families.

[C-reactive protein as a new risk factor of coronary heart disease in the population of young Polish males]. / Bialko C-reaktywne jako nowy czynnik zagrozenia choroba niedokrwienna serca w populacji mlodych zdrowych Polaków.

UNLABELLED: The aim of this study was to measure the levels of C-reactive protein (CRP) and examine their relationship with traditional risk factors of the coronary heart disease. Methods and participants. We examined a group of 150 males aged between 18 and 24. Each participant underwent physical examination and gave his previous medical history which included the place of residence, family background and current medication. In each case blood pressure was measured and body mass index (BMI) as well as waist/hip (W/H) ratio were established. The following biochemical parameters were measured in the serum of each participant: glucose, total cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A-I and B (Apo A, Apo B), uric acid and C-reactive protein. LDL-cholesterol level was obtained from Friedewald's formula. High sensitivity C-reactive protein (hs-CRP) was measured by automatic DADE-Behring nefelometer. RESULTS: The results underwent variation, correlation and regression analyses. The mean age of participants was 20.5 +/- 1.2 years. The mean BMI, W/H ratio, systolic and diastolic blood pressure as well as traditional coronary heart disease risk factors (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, uric acid, Apo A, Apo B) were within reference range. The mean CRP level was 0.135 +/- 0.24 mg/dl. There was statistically significant positive correlation between CRP level and W/H ratio. There was statistically significant negative correlation between CRP level and HDL-cholesterol and Apo-A levels. There was no statistically significant correlation between CRP level and smoking. CONCLUSIONS: Our study confirmed findings by other authors that there is a relationship between CRP level and other coronary heart disease factors such as W/H ratio and HDL-cholesterol. The lack of relationship between CRP level and smoking remains consistent with previous findings of Onat and Mendall. The mean CRP level in our study group was similar to CRP levels observed in large European populations.