Echocardiographic monitoring of left ventricular regional motion during hyperventilation and intravenous infusion of trometamol (tris) for detection of variant angina.

BACKGROUND: In spite of constant progress and development of new diagnostic tests, the detection of variant angina, which occurs in approximately 30% of patients with ischaemic heart disease (IHD), remains challenging. AIM: To assess the sensitivity and specificity of echocardiographically monitored transient abnormalities of regional wall motion of left ventricle (LV) during hyperventilation after intravenous infusion of trometamol (TRIS-buffer) for the detection of coronary artery spasm. METHODS: The study group consisted of 72 patients (14 women and 58 men, aged from 32 to 69 years) with IHD. A control group was composed of 20 healthy men. Patients with IHD were divided into two groups. Group I consisted of 46 patients with Prinzmetal's angina whereas group II was composed of 26 patients with exertional angina and a history of myocardial infarction. Two-dimensional echocardiographic monitoring of LV contractility was carried out during hyperventilation after an intravenous infusion of 100 ml of trometamol. RESULTS: Transient abnormalities of regional LV wall motion during infusion of trometamol and hyperventilation occurred in 91% of patients from group I and in 8% of patients from group II (p<0.00001). Electrocardiographic ST-segment changes during hyperventilation-trometamol test were observed in 63% of patients from group I and in 23% of patients from group II (p<0.0001). No transient regional dyssynergy of LV nor ST-segment changes during hyperventilation-trometamol test in the control group were observed. The sensitivity and specificity of regional LV wall motion during hyperventilation-trometamol test in the identification of patients with variant angina were 91% and 92%, respectively, and the sensitivity and specificity of ST-segment changes - 63% and 76%, respectively. CONCLUSIONS: Echocardiographic monitoring of regional LV wall motion during hyperventilation after intravenous infusion of trometamol is a sensitive and specific test for detection of variant angina.

[The examination of clinical prognostic importance of atrial and brain natriuretic peptide in patients with acute myocardial infarction]. / Badania nad klinicznym i prognostycznym znaczeniem przedsionkowego i mózgowego peptydu natriuretycznego u chorych na swiezy zawal miesnia sercowego.

Natriuretic peptides ANP, BNP and CNP with their receptors A, B, and C play an important role in maintaining the homeostasis. They have vasodilating, diuretic and natriuretic actions and regulate the systemic resistance. These peptides have been proved to contribute in pathogenesis of many diseases, for example heart failure, hypertension, acute coronary events or hepatic and renal insufficiency. The aim of our study was the estimation whether ANP or BNP could be markers of postinfarct heart failure in patients after thrombolytic therapy. The survey was made in 96 patients with acute myocardial infarction (AMI), who were treated in Department of Cardiology of University School of Medicine in Wroclaw. Patients were divided into 2 groups. The first group consisted of 56 patients with reperfusion after thrombolytic therapy and the second group created 40 patients without reperfusion. All patients were administered acethylsalicylic acid, 100 mg r-tPA (recombined tissue plasminogen activator) i.v. within 90 min and heparin in typical doses for the first 3-5 days. Venous blood samples for ANP and BNP estimation were taken before thrombolysis and then in 1st, 3rd, 5th and 30th day after treatment. We also measured the ejection fraction and activity of CPK and CK-MB in all the patients. Patients stayed under clinical observation for 12 months. Our study showed that the levels of ANP and BNP increase in 1st day after treatment in all patients with AMI. The normalization of ANP and BNP occurs in 3rd day after treatment in patients with reperfusion and in patients without reperfusion there are increased levels of these peptides even in 30th day. The increased level of BNP (> 160 pg/ml) is a significant risk factor of left ventricle systolic dysfunction, renewed AMI and sudden death in all patients with AMI after thrombolytic therapy whereas the increased level of ANP (> 100 pg/ml)--only in patients without reperfusion. Taking BNP as a marker of postinfarct heart failure it is possible to asses the risk of this complication in first day after thrombolytic therapy and choose the most proper treatment.

[Plasma urotensin II level in patients with chronic congestive heart failure]. / Stezenie urotensyny II w osoczu u chorych na przewlekla zastoinowa niewydolnosc serca.

Urotensin II (UTII) is recently discovered neurohumoral factor influencing function and structure of the myocardium and remodeling of the vessels, and it may contribute to pathogenesis of chronic congestive heart failure. The aim of the study was estimation of plasma concentration of UTII in patients with chronic congestive heart failure. The investigations were performed on 79 patients (37 women and 42 men) aged 43-87 yr. (mean 69.2 +/- 9.8 yr.) and 15 healthy individuals. In all patients, echocardiographic examination of the left ventricle structure and function was performed and serum concentration of electrolytes and creatinine were measured. Plasma levels of UTII were determined before treatment and after 1 week, 2 and 4 weeks of treatment using RIA Peninsula Lab. Inc. Plasma level of UTII in patients suffering from chronic congestive heart failure was significantly lower than in healthy individuals before the treatment and after achieving compensation of the circulatory system using standard treatment, independently from sex, kind of heart failure (systolic-diastolic or diastolic) or coexistence arterial hypertension or pulmonary hypertension, ischemic heart disease or diabetes and impaired glucose tolerance. Treatment of chronic congestive heart failure resulted in a transient increase in UTII concentration except for patients with diastolic heart failure or diabetes. Only patients without ischemic heart disease have a permanent increase in UTII concentration at the time of the treatment. After achieving compensation of the circulatory system in the patients suffering from systolic-diastolic heart failure, UTII concentration was significantly lower than in the patients suffering from diastolic heart failure, in the patients suffering from ischemic heart disease significantly lower than in patients without ischemic heart disease, in the patients with arterial hypertension significantly higher than in those with normal arterial tension, in group of the patients with pulmonary hypertension lower than in group of the patients without pulmonary hypertension and significantly higher in group of the patients suffering from diabetes or impaired glucose tolerance than in group of the patients without this metabolic disorders.

[Cytokines and remodeling of the heart in patients with congestive heart failure]. / Cytokiny a przebudowa miesnia serca u chorych na zastoinowa niewydolnosc serca.

Proinflammatory cytokines are capable of modulating cardiovascular function by a various mechanisms. The aim of the study was to evaluate the influence of the selected cytokines: tumor necrosis factor alpha (TNF-alpha), interleukin 1 (IL-1), interleukin 2 (IL-2), interleukin 6 (L-6), endothelin 1 (ET-1) on the remodeling of the heart in patients with congestive heart failure (1-year follow-up). The study was made in 45 patients with congestive heart failure treated in the Department of Cardiology. Of these, 31 were men aged from 44 to 77 and 14 were women aged from 48 to 79. Ischaemic heart disease was diagnosed in 22 patients and ischaemic heart disease and hypertension in 10 patients, dilated cardiomyopathy was diagnosed in 6 patients and postinflammatory cardiomyopathy in 7 patients. Blood samples for determination of TNF-alpha, IL-1, IL-2, IL-6, ET-1, aldosterone, catecholamines, brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) levels were obtained prior to the treatment and in 3 and 6 and 12 month follow-up. At the same time were estimated: NYHA functional class, structure, systolic and diastolic left ventricle function of the heart using echocardiography and 24-hour ECG Holter monitoring (HR, supraventricular and ventricular arrhythmias). TNF-alpha, IL-1, IL-2, IL-6, ET-1, aldosterone, catecholamines, BNP and ANP plasma levels were determined with radioimmunological assay. In patients with progression of congestive heart failure (worsening of NYHA class and ejection fraction of left ventricle) the plasma concentrations of TNF-alpha and ET-1 significantly increased in following observations. In this group patients we determined a correlation between ejection fraction of the left ventricle and serum concentration of TNF-alpha and ET-1. In patients with improving of NYHA functional class and ejection fraction of left ventricle the plasma concentrations of cytokines were not altering. In all patients the plasma concentration of TNF-alpha correlated with ANP and BNP concentrations.

[Influence of amlodipine on serum level of some cytokines in patients with congestive heart failure]. / Wplyw amlodypiny na stezenie wybranych cytokin u chorych na przewlekla niewydolnosc krazenia.

Recent studies showed higher plasma levels of several cytokines, such as interleukines or tumour necrosis factor in patients with congestive heart failure. Cytokines play a very important role in pathogenesis of congestive heart failure, because they impair contractility of heart muscle and cause damage of endothelium and myocytes due to their proinflammatory effects. One of the treatment modalities of heart failure might be administration of drugs inhibiting production of cytokines. The study was undertaken to evaluate whether beneficial effects of amlodipine in congestive heart failure are due to inhibition of synthesis of cytokines. The plasma levels of interleukine 6 (IL-6), tumour necrosis factor (TNF-alpha), neuropeptide Y (NPY) and endothelin-1 (ET-1) were determined in patients with congestive heart failure (NYHA II and III) before and after 30 days of treatment with amlodipine. 40 patients with congestive heart failure (CHF) treated in the Department of Cardiology of Medical University in Wroclaw participated in this study. In all patients CHF developed in the course of ischaemic heart disease and coexisting hypertension. Patients were divided into 2 groups dependingly on the NYHA classification. The first group consisted of 24 patients in II NYHA class, the other one--of 16 patients in III NYHA class. At 8 am, on the second day after admission and before treatment with amlodipine blood samples were taken from examined patients to determine plasma levels of IL-6, TNF-alpha, NPY and ET-1. Then patients were administered amlodipine at the dose of 5-10 mg per day. The next blood samples were taken on 5th and 30th day of treatment. Plasma levels of TNF-alpha, IL-6, NPY and ET-1 were estimated with radioimmunoassay using Medgerix kits. Our findings showed that plasma levels of TNF-alpha, IL-6, NPY and ET-1 in patients with CHF are increased. 30-days treatment with amlodipine caused significant decrease of TNF-alpha and IL-6 levels, but did not influence the plasma levels of NPY and ET-1. Amlodipine causes improvement of circulatory efficiency assessed according to NYHA classification. Treatment with amlodipine may be an additional way of therapy in CHF.

[Plasma levels of brain natriuretic peptide, cyclic 3'5'-guanosine monophosphate, endothelin 1, and noradrenaline in patients with chronic congestive heart failure]. / Stezenie mózgowego peptydu natriuretycznego, cyklicznego 3,5-guanozyno-monofosforanu, endoteliny-1 i noradrenaliny u chorych na przewlekla niewydolnosc krazenia.

Chronic congestive heart failure (CHF) is a complex clinical syndrome characterized by marked neurohormonal activation which may lead to further decompensation of the circulatory system. This study was undertaken to establish the role of certain hormones in pathogenesis of congestive heart failure. Plasma levels of brain natriuretic peptide (BNP), cyclic 3'5'-guanosine monophosphate (c-GMP), endothelin 1 (ET-1), and noradrenaline (NA) were examined in patients in patients with CHF and with decompensation of circulatory system. The survey was made in 92 patients with CHF, among them there were 42 females aged 50-76 years (mean 66 years) and 50 males aged 53-76 years (mean 68 years). All patients were divided into 3 groups according to NYHA classification. On admission blood samples were taken from all patients to determine plasma levels of BNP, c-GMP, ET-1, and NA. Then patients received captopril and furosemide. Next blood samples were taken between 5 and 7 day of the treatment, after entire remission symptoms of decompensation. Plasma levels of BNP, c-GMP, ET-1, and NA were estimated with radioimmunoassay. Our study showed that plasma levels of ET-1, BNP, c-GMP, and NA were increased in patients with CHF. 5-7 days of the treatment with ACE inhibitor and diuretic caused significant decrease of ET-1, BNP, and c-GMP levels, but did not influence NA plasma levels. Determination of ET-1, BNP, c-GMP, and NA plasma levels may be a noninvasive method useful in estimation of degree of CHF and efficacy of the treatment.

Plasma adiponectin concentration in relation to severity of coronary atherosclerosis and cardiovascular risk factors in middle-aged men.

UNLABELLED: Adiponectin, an adipocyte-derived protein, seems to be a link between obesity, insulin resistance, and atherosclerosis. The present study investigated the association between adiponectin and coronary artery disease in middle-aged men. MATERIAL AND METHODS: We examined 48 men (aged 40-60) with angiographically confirmed coronary atherosclerosis and 19 healthy men, matched by age, as a control group. Concentrations of glucose and lipids were estimated with enzymatic methods. Plasma level of adiponectin, total and free testosterone, estradiol, estrone, DHEA-S, and insulin were estimated with RIA commercial kits. RESULTS: Men with coronary atherosclerosis had lower plasma adiponectin level than controls (16.2+/-9.2 vs 20.5+/-6.7 microg/mL; p<0.05). However, after including BMI and waist as covariate data in ANCOVA, the difference in adiponectin levels between men with CAD and controls lost statistical significance (respectively for BMI and waist: p=0.4 and p=0.7). Moreover, although not significant, adiponectin levels decreased as a function of the number of significantly narrowed coronary arteries. In a priori comparison the lowest adiponectin plasma concentration was in men with three-vessel coronary artery disease (14.3+/-9.8 microg/mL) and the high-est in controls (20.5+/-6.8 microg/mL; p=0.09). Adiponectin plasma level correlated negatively (p<0.05) with BMI, waist, percentage of total fat, fasting-insulin-resistance index (FIRI), total cholesterol and triglycerides, and positively with quantitative insulin sensitivity check index (QUICKI), HDL cholesterol, total testosterone, and total testosterone/estradiol ratio. CONCLUSIONS: Our data suggest that low plasma adiponectin level is connected with insulin resistance syndrome and atherogenic lipid profile. It seems that adiponectin plays a role in pathogenesis of coronary atherosclerosis, especially in obese and insulin-resistant subjects.