Effectiveness of cardiogoniometry compared with exercise-ECG test in diagnosing stable coronary artery disease in women.

AIMS: To investigate the effectiveness of cardiogoniometry, a novel, non-invasive method, in diagnosing coronary artery disease (CAD) in women and compare it with exercise-ECG test, by using coronary angiography as a reference method. METHODS: It was a single-centre, case-series study including consecutive female patients with stable angina pectoris (AP) undergoing coronary angiography. Exercise-ECG test, done according to the Bruce protocol, and cardiogoniometry were obtained prior to coronary angiography. Clinically significant CAD has been defined as one or more coronary lesions with >70% stenosis. RESULTS: Study included 114 consecutive female patients with median age of 64.0 (58.0-71.0) years, out of which 32 (28.1%) had CAD. Cardiogoniometry yielded a total accuracy of 74.6% with a sensitivity of 75.0% (95% CI 56.6-88.5) and specificity of 74.4% (95% CI 63.6-83.4). Exercise-ECG test yielded a total accuracy of 45.1% with a sensitivity of 68.1% (95% CI 42.7-83.6) and specificity 36.6% (95% CI 25.2-50.3). Cardiogoniometry showed higher accuracy than exercise-ECG test ( P < 0.001). Pathological cardiogoniometry was associated with almost nine times higher risk for CAD (OR 8.7, 95%CI 3.4-22.3, P < 0.001), which remained significant after adjustment for age, and hypokinesia. CONCLUSION: Cardiogoniometry is a non-invasive, easy-to-use and free-of-risk method which showed high effectiveness in diagnosing stable CAD in women and superior to exercise-ECG test. Cardiogoniometry could be introduced as a part of the diagnostic algorithm of screening women for stable CAD and is suitable for use in the primary setting, especially in women unable to undergo stress-testing.

Hemodynamically unstable pericardial effusion in the Intensive Cardiac Unit: prospective study.

The authors have conducted a prospective investigation on 15 patients with hemodynamically unstable pericardial effusion (main criteria: echocardiographic signs of various degrees of right ventricular diastolic collapse and clinical instability) hospitalized in the Intensive Cardiac Unit (1.97% of all patients) for one year and have compared the results with literature data. The causes of pericardial effusion were neoplasms, infections, rupture of heart of aorta and hypothyroidism. Investigation revealed the most frequent findings: symptoms (dyspnea, retrosternal pain, loading intolerance, nonproductive cough), clinical signs (soft heart sounds, changes in pulmonal findings, fever, jugular venous distention, tachycardia, arterial hypotension and hepatomegaly), laboratory changes (elevated erythrocyte sedimentation rate, leukocytosis), ECG changes (ST-T abnormality, microvoltage, tachycardia) and chest X-rays changes (enlarged cardiac silhouette, pleural effusion). Echocardiography found an average width of pericardial effusion of 2.5 cm (+/- 1.2), frequently thickened pericardium and changes in heart motions. The most used drugs in therapy were indomethacin, antibiotics, analgesics and corticosteroids. In three patients pericardiocentesis, and in two pericardiectomy were performed. Two patients died, 13 patients were discharged from the ICU with an improved health condition. Literature data on this condition are either lacking, or differ from the above findings.

Metabolic syndrome X--high risk factor for acute myocardial infarction and its complications.

Metabolic Syndrome X is a clinical entity which comprises the following factors: diabetes mellitus, arterial hypertension, high levels of triglyceride and/or low levels of HDL cholesterol, central obesity and microalbuminuria (by WHO criteria). The first goal of this study was to determine the frequency of the Metabolic Syndrome X (MSX) in patients with acute myocardial infarction compared with the general population. The second goal of the study was to examine the frequency of heart failure and reinfarction rate in the patients with myocardial infarction, with and without MSX. Furthermore, the relationship between gender and MSX was analyzed. A total of 101 patients with acute myocardial infarction took part in randomized trial (32 women and 69 men). MSX and all of its components were diagnosed according to WHO criteria. To determine statistical significance of our results, we used chi2 test and t-test for independent samples. From 101 patient 48 had MSX (47.52%), while in the general population incidence of MSX is 3-4%. The reinfarction and the heart failure rate were significantly higher in the group of patients with MSX (p = 0.0067 and p = 0.0217, respectively). To conclude, the results of the present study confirm that MSX is a high risk factor for myocardial infarction and its complications.

Dominant right ventricular infarction: is angioplasty the optimal therapeutic approach?

Approximately 30% of all acute inferior myocardial infarctions (AIMI) are accompanied by acute right ventricular infarction (ARVI) as a consequence of proximal right coronary artery (RCA) occlusion. Fifty per cent of all patients with ARVI manifest hypotension, jugular venous distension, and dyspnoea with clear lung fields, which is then considered as dominant acute RVI (ARVI). The in hospital mortality rate of patients with ARVI who are treated traditionally is very high. Thrombolytic therapy is relatively ineffective, while primary angioplasty is a more recent approach yet to be established as optimal treatment for patients with ARVI. Thirty-eight patients with dominant ARVI were admitted to our CCU over a period of 24 months. The patients were retrospectively divided into 3 groups according to treatment: Group I (n = 16): traditional treatment; Group II (n = 12): thrombolytic therapy (streptokinase); Group III (n = 10): angioplasty after urgent coronarography. We tested the difference in the number of deaths in all groups by the Fisher exact test. There was a significant difference in the number of deaths between Group I and Group III (P < 0.05). Mortality reduction was also noted between Group II and Group III, which, however, proved to be statistically insignificant.