Clinical characteristics of patients with myocardial infarction treated in the regional hospital of Radomszczanski District in 2007-2009.

BACKGROUND: Cardiovascular diseases are responsible for about 50% of deaths in Poland. The clinical picture of coronary heart disease has been changing over recent years. AIM: To assess the changes of the clinical characteristics of myocardial infarction (MI) in the population of Radomszczanski District in 2007-2009. METHODS: The retrospective analysis included 756 patients aged between 29 and 93 years (306 women), who were hospitalised due to MI in the Department of Cardiology, District Hospital in Radomsko from 1 January 2007 to 31 December 2009. The following parameters were analysed: frequency of ST elevation MI (STEMI) and non ST elevation MI (NSTEMI) hospitalisations in subsequent years, age, gender, traditional risk factors (hypertension, diabetes, obesity, hypercholesterolaemia, hypertriglyceridaemia, smoking), comorbidities (atrial fibrillation, previous stroke and MI, chronic renal insufficiency) and all-cause in-hospital mortality. RESULTS: Observations have shown that during 2007-2009 the number of hospitalised STEMI increased (p = 0.011) while the number of hospitalised NSTEMI decreased (p = 0.011). The incidence of hypertension, diabetes, obesity, and dyslipidaemia did not change over the three years analysed (p > 0.05). In Radomszczanski District, compared to the Polish population, hypertension, obesity and previous MI occurred less frequently, especially in patients with NSTEMI. The incidence of smoking and diabetes was comparable to that in the Polish population with MI. Frequency of risk factors did not change over three years. CONCLUSIONS: Despite the increase of the hospitalised STEMI/NSTEMI ratio, the incidence of risk factors did not change in the population of Radomszczanski District over the analysed period.

[Role of echocardiography in monitoring of cardiac toxicity of cancer pharmacotherapy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging]. / Wspólczesna rola echokardiografii w monitorowaniu kardiotoksycznosci leków przeciwnowotworowych. Stanowisko grupy ekspertów polskiego Klinicznego Forum Obrazowania Serca i Naczyn.

Recent oncology development results in significant reduction of morbidity and mortality of several kinds of cancer. Such great achievements are at the cost of frequent cardiotoxicity, which predominantly is manifested as cardiomyopathy, cardiac dysfunction and heart failure (HF). Cardiotoxicity may manifest early - during treatment or late - after treatment completion. There are type 1 - anthracycline-related and type 2 - trastuzumab-related cardiotoxicity. Early detection of cardiotoxicity is crucial for preventing late heart dysfunction and HF. Baseline echocardiographic assessment should be performed in every patient before initiation of cancer treatment and serial monitoring of cardiac safety by means of echocardiography is recommended. The most widely used for this purpose is left ventricular ejection fraction (LVEF) calculated by Simpson's method with 2 dimensional transthoracic echocardiography. LVEF has numerous limitations, among which significant inter- and intraobserver variability, late decrease of LVEF with its often irreversibility are the most important. Noncontrast 3 dimesional echocardiography is the most reproducible technique for LVEF measurement. Newer echocardiographic technique - myocardial strain imaging has the potential to detect early subclinical cardiac dysfunction due to cardiotoxicity and may be used for the prediction of LV dysfunction. The role of other echocardiographic parameters, particularly of LV diastolic function has not been exactly defined in literature. The decision on discontinuation or modification of cancer therapy should be based on 2 improper, separate measurements of particular echocardiographic parameter or better more than 1 improper parameter should be taken into account. After completion of cancer treatment, echocardiography follow-up is recommended to detect late cardiotoxicity.

Heart remodeling induced by adjuvant trastuzumab-containing chemotherapy for breast cancer overexpressing human epidermal growth factor receptor type 2: a prospective study.

We aimed to investigate the cardiac changes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with trastuzumab in an adjuvant setting. Two hundred and fifty-three women with HER2-positive breast cancer were included. The assessment of cardiovascular system and echocardiography were performed and compared at baseline, at the termination of trastuzumab therapy and 6 months latter. Left heart remodeling was defined arbitrary as the change in at least one of the analyzed echocardiographic parameters of ≥standard deviation (SD) (in model I) or ≥2×SD (in model II) after 6-month follow-up. After 6-month follow-up 39 (31.7%), 27 (22%), 14 (11.4%), 10 (8.1%), 5 (4.1%) and 1 (0.8%), women had at least one parameter with a change exceeding mean difference ≥SD, respectively; and 30 (24.4%), 9 (7.5%), 3 (2.4%), 2 (1.6%) 1 (0.8%) exceeding mean difference ≥2SD. In stepwise multivariate regression analysis sedentary life style (OR16.7, p=0.003), positive cardiovascular family history (OR 6,9; p=0.013) and left ventricular ejection fraction change after 3 months (OR 1.2; p=0.007) were independent predictors of left heart remodeling in model I, whereas hypertension (OR 5.6; p=0.06) and positive cardiovascular family history (OR 3.9; p=0.032) were independent predictors of heart remodeling in model II. In conclusion, trastuzumab induces LV and left atrial cavity dilatation together with LV systolic function impairment.

[Cardioverter-defibrillator in the treatment of arrhythmia induced by trastuzumab used in the adjuvant setting in a patient with positive human epidermal growth factor receptor type-2 breast cancer]. / Kardiowerter−defibrylator w leczeniu arytmiiwywolanej trastuzumabem stosowanym w terapiiuzupelniajacej u chorej na raka piersi z nadekspresjanaskórkowego receptora wzrostu typu 2.

A case of a 36-year old woman with HER2-positive early breast cancer treated with adjuvant trastuzumab left ventricle dysfunction and cardiac arrest in ventricular fibrillation mechanism is presented. After having been successfully resuscitated, trastuzumab therapy was withheld, pharmacotherapy (beta-blocker, ACE-I) implemented and ICD was implanted. Echocardiography performed 6 months later, revealed normal systolic function of the left ventricle. The patient died despite further oncologic treatment due to progression of the disease. The authors discuss the approach to this dramatic but lone cardiac side effect of trastuzumab treatment.

Cardiac complications associated with trastuzumab in the setting of adjuvant chemotherapy for breast cancer overexpressing human epidermal growth factor receptor type 2 - a prospective study.

INTRODUCTION: Trastuzumab, a recombinant humanized monoclonal antibody, is targeted against the external domain of the human epidermal growth factor receptor type 2 (HER2). It improves efficacy of HER2-positive breast cancer treatment. The authors present their experience with patients (pts) treated with trastuzumab in the aspects of cardiac complications. MATERIAL AND METHODS: We observed prospectively 253 women with early positive HER2 breast cancer treated with trastuzumab. Assessment of cardiovascular status, ECG and echocardiography was performed initially and every 3 months until 6(th) month during follow-up. RESULTS: Cardiac complications developed in 52 pts (20.55%) and included: asymptomatic left ventricle dysfunction (43), symptomatic heart failure (6), new asymptomatic LBBB (1); new negative T-waves in ECG (2). There was a progressive decline in left ventricular ejection fraction (LVEF) during treatment. It was more enhanced in pts with cardiac complications. Following trastuzumab termination/discontinuation LVEF increased but at month 18 still remained significantly lower than initially in both groups (61.07 ±4.84 vs. 59.97 ±5.23 - no cardiac complications; p < 0.05; 58.14 ±4.08% vs. 53.08 ±5.74% - cardiac complications; p < 0.05). During 6-month follow-up 33 out of 46 pts experienced an improvement in left ventricular status. In 13 pts in whom trastuzumab was discontinued, it was restarted; 6 of them successfully completed total therapy. Univariate analysis revealed no association between any cardiovascular risk factor and the development of cardiotoxicity. CONCLUSIONS: One out of five treated patients discontinues trastuzumab in an adjuvant setting due to cardiac complications. LV dysfunction is the most frequent. Routine cardiac monitoring should be obligatory.

Left atrial size in hypertension and stroke.

INTRODUCTION: An enlarged left atrium is associated with increased risk for stroke. However, there are controversies regarding how left atrial size should be measured. MATERIAL AND METHODS: Echocardiography and carotid artery ultrasound were performed in 120 patients with essential hypertension (HT group) and in 64 hypertensive patients admitted with a first-ever ischemic stroke (HT-stroke group). Left atrial size was measured as antero-posterior diameter (LAD) and as left atrial volume (LAV) and indexed to body surface area (LADi/LAVi). All patients were in sinus rhythm and without mitral valve disease. RESULTS: In the HT-stroke group, LAVi and LADi were significantly larger as compared with the HT group (P ≤ 0.03 for all). In bivariate correlations, larger left atrial size was associated with higher SBPs and DBPs and significant carotid artery stenosis both in HT and HT-stroke groups (all P < 0.05). In multivariate logistic regression analysis, stroke was associated significantly with larger LAVi [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.06-2.65]; left ventricular mass index (OR 1.11, 95% CI 1.03-1.21); significant carotid artery stenosis (OR 1.09, 95% CI 1.03-1.24); and any carotid artery stenosis (OR 1.07, 95% CI 1.03-1.14). Analysis of receiver operating characteristic curves revealed that LAVi was the best left atrial measurement for prediction of stroke (OR 0.77, 95% CI 0.70-0.84). CONCLUSION: In hypertensive patients, a first-ever ischemic stroke was associated with larger left atrial size, left ventricular mass index and internal carotid artery stenosis. LAVi was the left atrial measurement most closely associated with ischemic stroke.

High sensitivity C-reactive protein, NT-proBNP and hemodynamic left ventricular function in acute coronary syndrome without ST segment elevation - a preliminary report.

BACKGROUND: Prognostic factors in acute coronary syndromes have been the subject of interest in cardiology over the last few years. Our study aimed to compare humoral marker concentration shifts (hsCRP, Nt-proBNP) and hemodynamic left ventricular systolic function index changes, determined by means of echocardiography in the first hours of acute coronary syndromes (ACS). MATERIAL/METHODS: The study comprised 33 patients with ACS without ST segment elevation. Group I consisted of 18 patients (11 men, 7 women aged from 48 to 77, mean age 67+/-35 years) with unstable angina pectoris (uAP). Group II consisted of 15 patients (10 men, 5 women aged from 51 to 80, mean age 70+/-11.9 years) with myocardial infarction without ST segment elevation (NSTEMI). In all patients, Nt-proBNP and hsCRP blood concentrations were determined between the 6th and 12th hours after admission to the intensive coronary care unit. On the 2nd-3rd day, after coronary stabilization, routine echocardiography was performed in each patient to assess left ventricular function. RESULTS: A positive correlation between hsCRP and Nt-proBNP in uAP was observed in group I. In group II, in patients with NSTEMI no such correlation was observed. There was also no correlation in either study group between humoral (hsCRP and Nt-proBNP) and hemodynamic parameters. CONCLUSIONS: The complex evaluation of the post-ACS prognosis should be multifaceted. It should contain hemodynamic assessment of the left ventricle by means of echocardiography as well as humoral coronary risk markers.

Prognostic value of NT-proBNP levels in patients undergoing permanent pacemaker implantation.

INTRODUCTION: Several reports confirmed the prognostic value of the N-terminal fragment of B-type natriuretic peptide prohormone (NT-proBT) in various patient populations. Patients with medical indications for implantation of an artificial cardiac pacemaker are at high risk of cardiovascular events. There is limited data assessing the prognostic value of NT-proBNP in this group. OBJECTIVES: The aim of the study was to establish the prognostic value of NT-proBNP in patients scheduled for the implantation of a cardiac stimulator. PATIENTS AND METHODS: The study included 59 patients (average age 79.8 +/-6.3 years) with indications for implantation of a permanent pacemaker. NT-proBNP was measured in each patient on admission and 46 patients had their NT-proBNP measured 1 month after implantation. All patients were followed up for 4 years. We examined the incidence of cardiovascular events as endpoints. Finally, we analyzed the relationship between the initial concentration of NT-proBNP measured on admission and at 1 month and the risk of the occurrence of the endpoint (analysis in the group in whom events occurred vs. group without the endpoint). RESULTS: NT-proBNP values at baseline and at 1 month (NT-proBNP1month) were significantly higher in patients who experienced cardiovascular events than in those who were free of such events (NT-proBNP: 2310.6 +/-2657.7 pg/ml vs. 1177.6 +/-1364.6 pg/ml, P <0.2; NT-proBNP1month: 2538 +/-3341.4 pg/ml vs. 1139.4 +/-1294.1 pg/ml, P <0.03, respectively). A cut-off point of the initial NT-proBNP value of 577 pg/ml was estimated as the most accurate prognostic risk factor for cardiovascular events within a 4-year follow-up (sensitivity 77%, specificity 52%). CONCLUSIONS: The level of NT-proBNP prior to as well as 1 month after cardiac pacemaker implantation can be useful in identifying patients with higher risk of future cardiovascular events. We suggest using the baseline NT-proBNP concentration of 577 pg/ml as a cut-off value for assessing the risk for such events.

Left atrial and left atrial appendage systolic function in patients with post-myocardial distal blocks.

INTRODUCTION: The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances. MATERIAL AND METHODS: The study comprised 59 patients with persistent post-myocardial distal blocks, who were allocated to one of the three following subgroups: study group I - 20 patients with left bundle branch block (LBBB); study group II - 20 patients with right bundle branch block (RBBB), and study group III -19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts - group IV) and clinically healthy people (16 patients - group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE). RESULTS: We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively. CONCLUSIONS: Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances.

Correlation analysis of atrial natriuretic peptide concentration, echocardiographic left atrial and left ventricular dimensions, and renal function parameters in patients after permanent pacemaker implantation.

BACKGROUND: Atrial endocrine function was established in the second half of the 20th century, confirming the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the physiology of the cardiovascular system. The present study was undertaken to evaluate changes in ANP and echocardiographic parameters within the first month after VVI and DDD pacemaker implantation and to evaluate correlations between the parameters. METHODS: The study population consisted of group I--20 VVI patients aged 71-90 years (mean age 77.5 +/- 5.9) and group II--20 DDD/VDD patients aged 49-81 years (mean age 68.9 +/- 11). Fifteen healthy volunteers aged 58-80 years (mean age 72.7 +/- 2.8) served as controls. Correlations between ANP levels and cardiac cavity dimensions and between ANP and parameters of renal function were studied. RESULTS: Blood levels of ANP decreased after pacemaker implantation: in the VVI group from 168.61 +/- 81.95 pg/1000 microL to 118.04 +/- 61.06 pg/1000 microL at 7 days and to 121.4 +/- 71.90 pg/1000 microL at 30 days; and in the DDD/VDD group from 134.89 +/- 83.11 pg/1000 microL to 104.96 +/- +/- 57.09 pg/1000 microL at 7 days and to 110.82 +/- 53.32 pg/1000 microL at 30 days. There was a significant correlation between ANP levels and left atrial size in the DDD/VDD group--0.598 (p = 0.005) and 0.593 (p = 0.005) and left ventricular dimensions--0.499 (p = 0.024) and 0.485 (p = 0.030). CONCLUSIONS: ANP decreases significantly after pacing implementation in patients selected for implantation of VVI and DDD/VDD pacemakers. ANP correlates significantly with echocardiographic measurements in patients selected for DDD/VDD pacemakers, but no significant correlation is observed in VVI patients qualifying for permanent pacemaker due to atrioventricular block.

Post-myocardial infarction intraventricular conduction defects and B-type natriuretic peptide levels.

BACKGROUND: Levels of B-type natriuretic peptide (BNP), a significant marker of left ventricular (LV) dysfunction, may provide information on the severity of heart failure in patients with intraventricular conduction defects (IVCD).The aim of this study was to measure serum BNP levels in post-myocardial infarction (MI) patients with IVCD. METHODS: In 2004-2005 during standard follow-up at 6 mo after acute MI in 158 subjects, BNP was measured using an immunoenzymatic method. Of them, 126 patients had IVCD: 31, left bundle branch block (LBBB); 36, right bundle branch block (RBBB); 30, left anterior hemiblock (LAH); and 29, left posterior hemiblock (LPH). Thirty two patients with a previous MI, but without IVCD, served as controls, whereas 15 healthy subjects entered the comparative group. RESULTS: In post-MI patients with IVCD, the mean BNP level was significantly higher than in their counterparts without IVCD (p < 0.001) and in healthy subjects (p < 0.001). The highest BNP level was found in patients with LBBB and RBBB. In patients with LAH and LPH, levels of BNP were insignificantly higher than in patients without IVCD. CONCLUSIONS: Significantly higher BNP levels in patients with previous MI and IVCD suggest more severe heart failure than in their counterparts without IVCD with comparable LV ejection fraction.

Plasma B-type natriuretic peptide as a marker of myocardial asynchrony.

OBJECTIVES: Myocardial asynchrony in postinfarction patients with intraventricular conduction defects (IVCD) may influence plasma levels of B-type natriuretic peptide (BNP). The aim of the study is to evaluate asynchrony parameters in postinfarction patients with IVCD and to define the relationship between plasma levels of BNP and echocardiographic parameters of asynchrony. METHODS: The study included 158 patients 6 months after myocardial infarction (MI): 126 patients with IVCD and 32 patients without IVCD. Plasma levels of BNP were measured using an immunoenzymatic method. Left ventricular (LV) function was evaluated in echocardiography. RESULTS: In patients with post-MI IVCD, the mean plasma level of BNP was 280.2 +/- 340.2 versus 181.7 +/- 270.4 pg/ml (p < 0.001) and they had significantly higher parameters of interventricular asynchrony as compared with subjects without postinfarction IVCD. Multifactorial regression analysis showed that in patients with an ejection fraction (EF) > or =50%, interventricular asynchrony and intraventricular delay significantly influenced the BNP level. In patients with an EF <50%, BNP levels were correlated with the magnitude of the EF. CONCLUSION: Plasma levels of BNP 6 months after MI depend not only on parameters of LV function but also on LV asynchrony and may serve as its marker in patients with IVCD and preserved LV systolic function.

Myocardial asynchrony in patients with postinfarction intraventricular conduction defects.

BACKGROUND: Postinfarction intraventricular conduction defects lead to asynchronous activation of the myocardium. HYPOTHESIS: The aim of the current study is to evaluate contraction asynchrony in postinfarction patients with intraventricular conduction defects. METHODS: A total of 158 patients 6 months postmyocardial infarction and 15 healthy subjects underwent echocardiography to evaluate atrioventricular, interventricular, intraventricular asynchrony, and myocardial performance index (MPI). A subgroup of 126 patients had intraventricular conduction defects in ECG, whereas 32 with normal QRS complex served as controls. RESULTS: All patients postmyocardial infarction showed intraventricular asynchrony and markedly higher MPI. Comparing groups with and without intraventricular conduction defects postmyocardial infarction, those with left bundle branch block (BBB) had significantly higher parameters of all asynchrony types; those with right BBB and left posterior hemiblock (LPH) had significantly higher interventricular asynchrony parameters; those with left anterior hemiblock did not show significant differences in asynchrony parameters as compared with subjects without postinfarction conduction defects. CONCLUSIONS: (1) Patients 6 months postmyocardial infarction show intraventricular asynchrony and markedly higher MPI. (2) Postinfarction patients with LBBB have the highest parameters of atrioventricular, interventricular and intraventricular asynchrony as compared with postinfarction patients with other and without conduction defects. (3) In postinfarction patients with RBBB or LPH parameters of interventricular asynchrony are significantly higher as compared with postinfarction patients without intraventricular conduction defects.

[Thyrometabolic disorders and heart failure]. / Zaburzenia tyreometaboliczne a niewydolnosc serca.

Thyroid hormones are essential to maintain normal function of many systems including the cardiovascular system. Their excess or deficiency may upset human body homeostasis. Hyperthyroidism leads to cardiovascular system's hyperdynamic status which is characterized by tachycardia, increased difference between systolic and diastolic arterial pressure, significant increase of the stroke volume and improvement of the left ventricular diastolic function. Long-lasting thyrotoxicosis in patient with heart disease may result in atrial fibrillation, deterioration of angina pectoris or congestive heart failure. Hypothyroidism leads to hemodynamic disturbances which are quite different than those observed in hyperthyroidism, but cardiac symptoms are scant in clinical practice. Hypothyroidism's clinical significance is limited to atherosclerosis progression and intensification of ischaemic heart disease symptoms. Both leads to symptomatic cardiovascular system failure or its deterioration. We should emphasize that cardiovascular system dysfunction associated with thyrometabolic disturbances subsides when euthyreosis is restored. It sounds promising that there are reports suggesting a potential advantage of thyroxin treatment in patients with acute or chronic cardiovascular system diseases. These hypotheses result from the observations that heart dysfunction in hypothyroidism is similar to that observed in heart failure.

[Perioperative cardiac arrhythmias in patients undergoing surgical treatment for lung cancer]. / Zaburzenia rytmu serca w okresie okolooperacyjnym u osób leczonych chirurgicznie z powodu raka pluca.

INTRODUCTION: Thoracic surgery is associated with a high risk of morbidity and mortality. Cardiac arrhythmias are the most common and severe complications in early postoperative period. OBJECTIVES: Evaluation of the prevalence and causes of cardiac arrythmias, factors that predispose to their occurrence and their influence on general state of health in short-term postoperative period. PATIENTS AND METHODS: The study was performed in 80 patients with proven primary non-small cell lung cancer. We analyzed demographic data, type of carcinoma, presence of other diseases, laboratory results, and echocardiograms performed 2 times before and after operation and 24-hour Holter monitoring obtained 3 times--a day before thoracotomy and on the 1st and 5th postoperative day. RESULTS: There were no significant changes in a total number of supraventricular ectopic beats during 3 consecutive 24-hour Holter recordings. The second Holter recording performed on the 1st postoperative day showed a statistically significant increase (p < 0.05) in the number of ventricular premature beats, which persisted on a similar, higher level on the 5th day. Twenty-four patients (30%) developed atrial fibrillation (AF) in the postoperative period. The average time of the duration of AF was 2.62 days with the peak incidence during 1st and 2nd day after operation (total 62.5%). Apart from cigarette smoking, no other epidemiological and clinical variables affected the occurrence of postoperative AF (p > 0.05). CONCLUSIONS: Paroxysmal atrial fibrillation is the most common type of arrhythmias in early postoperative period after thoracic surgery. Patients who underwent thoracic surgery should be under cardiological surveillance during the first postoperative days. Routine prevention with anticoagulants in patients after pulmonary tumor resection should be implemented based on their current clinical condition.

NT-proBNP plasma levels and echocardiographic assessment of cardiac function in patients after renal transplantation.

BACKGROUND: Cardiovascular diseases are the most important causes of death in patients with chronic renal disease (CRD). Successful renal transplantation (RTx) corrects water and electrolyte disturbances and decreases or eliminates anaemia. It favourably influences cardiac haemodynamics and reduces risk of cardiovascular events. NT-proBNP plasma concentration is one of the prognostic and risk factors in such cases, whereas echocardiography that enables evaluation of the left atrium and ventricle allows detailed analysis of haemodynamic condition of the heart. AIM: To analyse NT-proBNP plasma concentration and selected echocardiographic parameters in patients after RTx at various time intervals after the procedure. METHODS: Seventeen patients after RTx were included in the study (age 46.5+/-16 years, 7 men and 10 women). NT-proBNP plasma level measurements and echocardiography were performed immediately before and at 3 and 6 months after RTx. Additionally, these parameters were assessed in patients receiving cyclosporine A (CsA) and tacrolimus (TAC). RESULTS: NT-proBNP plasma level decreases significantly after RTx (initially 4369+/-2420, at 3 months 2056+/-576, at 6 months 1580+/-572 pg/ml). In the TAC group, a significant reduction was observed at 3 months (from 13291+/-3563 to 1845+/-1022 pg/ml). In patients treated with CsA reduction occurred at 6 months after RTx (from 9447+/-3369 to 1246+/-436 pg/ml). At six-month follow-up significant changes in ejection fraction were not found. However, a significant increase in LV mass in CsA patients was observed. CONCLUSIONS: Reduction of NT-proBNP levels seems to be more the result of transplanted kidney function than of an improvement in circulation. Significant LV mass increase in CsA patients may be a result of higher blood pressure levels observed before and after RTx.

Does permanent cardiac stimulation through atrial natriuretic peptide secretion influence the basic parameters of renal function?

BACKGROUND: The aim of this study was to evaluate atrial humoral function and renal function after pacemaker implantation due to atrioventricular conduction disturbances. We analyzed blood atrial natriuretic peptide (ANP) concentration and basic parameters of renal function within 1 month of implantation of VVI and DDD pacemakers. We evaluated correlations between blood ANP values and basic renal function parameters. METHODS: We studied two groups of patients with atrioventricular (AV) conduction disturbances: second-degree AV block and third-degree AV block. Group I comprised 20 patients aged 71-90 years (median 77.5 +/- 5.9 years) in whom permanent VVI pacing was applied, and group II consisted of 20 subjects aged 49-81 years (median 68.9 +/- 11.9 years) in whom DDD/ /VDD pacemakers were implanted. The control group consisted of 15 healthy volunteers aged 58-80 years (median 72.7 +/- 2.8 years). Plasma concentration of ANP was determined by radioimmunoassay. The parameters of renal function we analyzed with Jaffe's colorimetric and kinetic test. RESULTS: Patients in group I showed a significant decrease in blood concentration of ANP from 168.1 +/- 81.9 pg/1000 mL to 118.0 +/- 61.1 pg/1000 mL (p < 0.01) 7 days after implantation. At 30 days, ANP was 121.4 +/- 71.9 pg/1000 mL. In group II, plasma concentration of ANP decreased significantly from 134.9 +/- 8.1 pg/1000 mL to 104.9 +/- 6.1 pg/1000 mL (p < 0.01) 7 days after implantation and to 110.8 +/- 53.3 pg/1000 mL at 30 days. Patients in group I had elevated, albeit insignificantly, clearance of creatinine to 76.1 +/- 17.8 ml/min at 7 days (p > 0.05) which increased significantly to 85.0 +/- 17.9 ml/min at 30 days. In group II, clearance of creatinine increased insignificantly to 84.6 +/- 13.2 ml/min (p < 0.05) at 7 days and was significantly elevated to 96.9 +/- 18.2 ml/min (p < 0.05) at 30 days. In group I, plasma concentration of creatinine decreased significantly (p < 0.05) to 1.15 +/- 0.30 mg/dl at 7 days and to 1.01 +/- +/- 0.21 mg/dl at 30 days. In group II, there was a significant decrease (p < 0.05) to 1.15 +/- 0.24 mg/dl at 7 days and to 1.08 +/- 0.27 mg/dl at 30 days. There was a positive correlation between creatinine clearance and plasma ANP concentration in groups I and II (r = 0.301; p < 0.05). CONCLUSIONS: In patients with a pacemaker implanted due to atrioventricular disturbances, blood concentration of ANP was decreased. Renal function was improved after pacemaker implantation. (Cardiol J 2007; 14: 568-572).

Atrial natriuretic peptide for monitoring cardiovascular system performance following pacemaker implantation.

BACKGROUND: The effects of different modes of pacing on cardiac performance have been investigated in a few small studies, and the results are not conclusive. AIM: To assess the effects of different modes of pacing on atrial natriuretic peptide (ANP) plasma concentration and left ventricular ejection fraction (LVEF). METHODS: The study group consisted of 55 subjects without symptomatic CHF. Forty patients were in sinus rhythm and had a-v block. Twenty of them, aged 71-90 years, mean 77.5+/-5.9 years, received VVI pacemaker, and the remaining 20 patients aged 49-81 years, mean 68.9+/-11.9 years, received DDD or VDD pacemakers. The control group consisted of 15 healthy volunteers aged 58-80 years, mean 72.6+/-2.8 years. Blood samples for alpha ANP concentration were taken before pacemaker implantation and 7 as well as 30 days after pacemaker implantation. In controls, a single alpha ANP measurement was performed. Transthoracic echocardiography was performed in all patients and controls at the same time-points as ANP assessment in order to calculate LVEF. RESULTS: Before pacemaker implantation, ANP plasma concentration was the highest in VVI patients and was significantly greater in patients than in controls. Following VVI pacemaker implantation, ANP level significantly decreased, both 7 and 30 days after implantation when compared with baseline values. Also following implantation of dual-chamber pacing system, ANP concentration significantly decreased. The baseline LVEF values were significantly higher in patients than in controls. In patients with VVI pacemakers, LVEF significantly increased, both 7 and 30 days after implantation. In patients with dual-chamber pacemakers, LVEF tended to increase 7 days after implantation and slightly decreased 30 days after implantation, however, the differences were not significant. CONCLUSIONS: ANP level decreases following pacemaker implantation in patients with advanced a-v block which suggests an improvement of cardiac performance. Assessment of ANP may be useful in selection of pacing mode.

Adenosine-activated myocardial ischemia does not induce delayed preconditioning.

BACKGROUND: Our objective was to determine whether adenosine-induced ischemia exerts a delayed cardiac protective effect in patients with stable effort angina ischemic heart disease. MATERIAL/METHODS: The study group was comprised of 32 patients (men) with symptoms of stable effort angina, aged 38-65 years (Group 1), and 18 clinically healthy subjects (3 women, 15 men), aged 35-55 years (Control group). The study protocol included baseline ECG and treadmill echocardiogram (ET1); ECG and adenosine echocardiogram performed 7 days after ET1; repeated exercise test exactly 24 h after adenosine infusion (ET2). Increases in heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, maximum ST-segment depression (max IST) and total ST-segment depression (SIST) on ECG were compared, as well as left ventricular end-diastolic volume (LVEDV), end-systolic (LVESV) volume, ejection fraction (EF), and wall motion synergy index (WMSI). RESULTS: No statistically significant differences were found in the increased values of the investigated electrocardiographic and echocardiographic parameters in either group on either exercise test. The only positive trend was observed in LVEDV. In Group 1 LVEDV increased significantly from rest values during ET1, whereas during ET2 LVEDV did not change. CONCLUSIONS: Adenosine-induced ischemia does not exert a delayed protective effect in respect to cardiac bioelectrical and mechanical functions in patients with ischemic heart disease in the form of stable effort angina.