Prognostic Significance of NT-proBNP Levels in Patients over 65 Presenting Acute Myocardial Infarction Treated Invasively or Conservatively.

OBJECTIVES: Assessment of prognostic significance of NT-proBNP level and the effects of invasive (I) and conservative (C) treatment of acute myocardial infarction (AMI) in patients over 65. MATERIALS AND METHODS: One-year survival was assessed in 286 consecutive patients with AMI aged 65-100 (79 ± 8) subjected to I or C treatment (136 and 150 individuals), respectively. RESULTS: 245 (85%) patients survived in-hospital stay: 124 (91.1%) received I treatment and 121 (80.6%) received C treatment. Heart failure (HF) was diagnosed in 30 patients receiving I treatment (22.6%) and in 71 subjected to C treatment (47.3%), p < 0,0001. NT-proBNP levels in the latter group were significantly higher than in the 185 patients without HF (12311 ± 13560 pg/mL versus 4773 ± 8807 pg/mL, p < 0.0001). NT-proBNP levels after coronary angioplasty were lower than in patients receiving C treatment (5922 ± 10250 pg/mL versus 8718 ± 12024 pg/mL, p = 0.0002). Left ventricular ejection fraction was significantly higher in I patients than in C patients (47 ± 13% versus 42 ± 11.6%, p = 0.004). During the one-year follow-up, 82.3% of I patients and 61.2% of the C patients survived (p < 0.0003). There was a significantly lower probability of death at NT-proBNP below 8548.5 pg/mL. CONCLUSIONS: The NT-proBNP level in the first day of AMI is a good prognosticator. One-year follow-up prognosis for patients who received I treatment in the AMI is better than that for C patients. I patients exhibit superior left ventricular function after angioplasty and in the follow-up.

[Aspiration thrombectomy during percutaneous coronary intervention in a patient with cardiogenic shock caused by left main occlusion]. / Zastosowanie trombektomii aspiracyjneju pacjenta we wstrzasie kardiogennym z niedroznoscia pnia lewej tetnicy wiencowej.

CASE STUDY: 56-year-old male patient in cardiogenic shock with a large thrombus in LM, succesfully treated by PTCA with aspiration thrombectomy. FOLLOW-UP: 9 months control angiography.

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

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

Left ventricular performance and exercise capacity in patients aged 65 years and older treated by primary coronary angioplasty or conservatively for acute myocardial infarction--a one-year follow-up.

BACKGROUND: Elderly patients hospitalised for congestive heart failure (CHF) due to myocardial infarction (MI) have very poor prognosis, particularly if CHF symptoms are caused by left ventricular (LV) systolic dysfunction. Early invasive strategy is considered the best method of preventing post-MI LV dysfunction. The clinical impact of early invasive strategy on prognosis in elderly patients with acute MI has yet to be completely defined because of the poor enrolment of elderly patients in large randomised trials. AIM: To asses whether treatment of acute MI in patients aged >65 years using percutaneous coronary intervention (PCI) results in significantly better long-term cardiovascular performance in comparison with conservative treatment (CT). METHODS: Our study involved 90 MI patients who underwent diagnostic spiroergometry: 40 patients (mean age 73 years) treated conservatively and 50 (mean age 71 years) by PCI. Echocardiographic examinations and spiroergometric tests were performed at 3-, 6- and 12-month follow-up. Plasma NT-proBNP levels were measured on admission and at 6- and 12-month follow-up. RESULTS: Echocardiographic and spiroergometric parameters were significantly better in PCI patients in each of the analysed periods and showed significant improvement throughout follow-up (the largest between months 3 and 6). In the CT patients these parameters showed significant improvement only between months 3 and 6. After one year, studied parameters were better in PCI patients (LVESD: 3.1+/-0.4 vs. 3.5+/-0.6 cm; p <0.001, LVEF: 62.8+/-6.6 vs. 55.8+/-8.3%; p <0.001, LVEDD: 4.9+/-0.4 vs. 5.1+/-0.5 cm; p=0.03, duration of exertion: 578+/-73 vs. 528+/-108 s; p=0.011, METS: 6.2+/-1.0 vs. 5.7+/-1.1; p=0.002, peak VO2: 22+/-3.4 vs. 20.3+/-3.4 ml/kg/min; p=0.02, VE/VCO2: 29.1+/-4.4 vs. 33.3+/-4.7; p <0.001, VE/VCO2 slope: 23.2+/-4.7 vs. 27.5+/-5.1; p <0.001). The groups did not differ in peak VO2 expressed as peak VO2 % predicted and plasma NT-proBNP levels. Over the whole follow-up period NT-proBNP levels were negatively associated with LVEF, peak VO2 and MET, and positively with LVESD and LVEDD recorded at 3 months. In each of the analysed periods spiroergometric parameters significantly correlated with echocardiographic indices recorded at 3 months. CONCLUSIONS: Early PCI for acute MI in patients aged >65 years results in significantly better long-term cardiovascular performance than conservative treatment. The patients showed the most significant improvement in LV performance and exercise capacity between months 3 and 6.

[Use of intermittent ultrafiltration in decompensated, diuretic-resistant heart failure--six case reports]. / Zastosowanie ultrafiltracji zylnej w leczeniu chorych z ciezka, oporna na leczenie zastoinowa niewydolnoscia serca--opis szesciu przypadków.

Veno/venous ultrafiltration is a novel alternative method of treatment in patients with decompensated heart failure with fluid retention. Intermittent ultrafiltration treatment was used in 6 patients (mean age of 58+/-2 years) with decompensated heart failure and volume overload occurring despite optimal pharmacological treatment. Patients received 3.5+/-1 ultrafiltration treatments, with each treatment removing 2500+/-200 ml of fluid. There were no significant procedure-related complications. One patient died due to progression of heart failure whereas 5 patients were successfully discharged from hospital on oral furosemide.

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

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

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

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

[Left main coronary artery stenting in a ninety year old female with recurrent acute coronary syndrome -- a case report]. / Stentowanie pnia lewej tetnicy wiencowej u 90-letniej chorej wracajacej do szpitala z powodu ostrego zespolu wiencowego. Opis przypadku.

A case of a ninety year old female with recurrent acute coronary syndrome is presented. Coronary angiography revealed critical left main coronary artery stenosis which was successfully treated with angioplasty and stent implantation. Data from literature on the left main stenting in the elderly are discussed.

[Acute coronary syndrome without ST segment elevation in a patient with familial hypertrophic cardiomyopathy--a case report]. / Ostry zespól wiencowy troponino-dodatni bez uniesienia odcinka ST u chorego z rodzinna kardiomiopatia przerostowa.

Acute coronary syndrome without ST segment elevation in a patient with familial hypertrophic cardiomyopathy. A case of a 46-year-old male with hypertrophic cardiomyopathy and cardioverter-defibrillator implanted due to a history of syncopal sustained ventricular tachycardia, is presented. The patient had undergone coronary angiography two years before current hospitalisation which showed normal coronary arteries. This time the patient was admitted to the hospital due to a typical chest pain. ECG showed predominantly paced QRS complexes and negative T waves in V2-V6 which were present on ECG recorded a few months earlier. Troponin I plasma concentration was significantly elevated. Coronary angiography revealed critical stenosis of the left anterior descending coronary artery which was successfully treated with angioplasty and stent implantation. Diagnosis and treatment of patients with hypertrophic cardiomyopathy are discussed.