The role of chemokine CCL5/RANTES and metalloproteinase-9 as inflammatory modulators in symptomatic internal carotid artery stenosis.

Up to 80% of all ischemic strokes (IS) attributed to internal carotid athero-occlusive artery stenosis (ICAS) are related to a thromboembolic mechanism. One athero-occlusive ischemic event increases the risk for ischemia in another vascular territory, resulting from inflammation within the atherosclerotic plaque induced by cytokines. Thus, ultrasonographic characteristics of vulnerable plaques in ICAS, including plaque echolucency and ulceration might correspond to cytokine activity. The present study aimed to investigate the associations between serum cytokines and atherosclerotic plaque characteristics and the 3-year risk of a major adverse coronary and carotid ischemic event (MACCE) in symptomatic patients treated for ICAS. Plaque characteristics on ultrasonography, serum levels of C-C motif chemokine ligand 5 (CCL5)/regulated on activation, normal T-cell expressed and secreted (RANTES), metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), transforming growth factor beta (TGF-ß), C-X-C motif chemokine ligand 16 (CXCL16), FAS ligand (FASL) and high sensivity C-reactive protein (hs-CRP) were analyzed in 103 symptomatic patients with ICAS prior to carotid revascularization. The incidence of MACCE: cardiovascular death (CVD), myocardial infarction (MI) and recurrent ischemic stroke (IS) were recorded prospectively for up to 5 years (median 37; IQR 21 - 40 months). Echolucent plaques, in comparison to echogenic plaques, displayed lower median levels of RANTES (P = 0.042) but higher median levels of IL-6 (P = 0.039). There was no relationship between plaque characteristics and median levels of MMP-9, TGF ß, CXCL16, FASL, or hs-CRP (P = NS). During follow-up, MACCE occurred in 15 (14.6%) patients. Univariate Cox proportional hazard analysis indicated median RANTES levels < 45.5ng/mL (hazard ratio (HR) = 3.95; 95%CI = 1.10 - 14.2; P = 0.035), MMP-9 > 0.6 µg/mL (HR 4.5; 95%CI = 1.4 - 13.9; P = 0.009), renal impairment (HR 3.48; 95%CI = 1.29 - 9.34; P = 0.013) as potential MACCE risk factors. On multivariate Cox proportional hazard analysis, MMP-9 > 0.6 µg/mL and RANTES < 45.5 ng/ml were associated with a 4.72-fold (95%CI = 1.3 - 17.0; P = 0.017) and a 3.8-fold risk increase (95%CI = 1.07 - 13.89; P = 0.038) of MACCE. Kaplan-Meier analysis showed significant differences in MACCE-free survival rates depending on RANTES and MMP-9 median levels. We conclude that serum RANTES, IL-6, and MMP-9 were associated with plaque vulnerability and predicted adverse MACCE in patients treated for ICAS.

Association of increased carotid intima-media thickness with the extent of coronary artery disease.

OBJECTIVE: To investigate (a) the relation between intima-media thickness (IMT) in carotid arteries and the extent of coronary artery disease (CAD); and (b) whether IMT is predictive of coronary atherosclerosis. The coexistence of severe extracranial atherosclerosis in patients with CAD was also analysed. METHODS: Coronary angiography and carotid ultrasound evaluation were performed in 558 consecutive patients (438 men), with a mean (SD) age of 58.8 (9.2) years and suspected CAD. Mean IMT was measured at both carotid arteries and expressed as the mean aggregate value. The relation between IMT and severity of CAD was determined. RESULTS: A significant correlation between mean IMT and advancing CAD (p < 0.0001) was found. Four independent predictors of CAD were found in the discriminant analysis: age (p = 0.0193), hyperlipidaemia (p < 0.0001), smoking (p = 0.0032), and IMT (p < 0.0001). A significant increase in IMT was observed among patients with one, two, and three vessel CAD. A log normal distribution of IMT values showed that if mean IMT was over 1.15 mm, patients had a 94% probability of having CAD, with sensitivity of 65% and specificity of 80% in the patients with a high risk of CAD. The number of critically stenosed extracranial arteries increased with advancing CAD. None of the patients with normal coronary arteries had severe stenosis of the extracranial arteries. Severe carotid, vertebral, or subclavian stenosis was found in 16.6% of patients with three vessel CAD. CONCLUSIONS: IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD.

Clinical and angiographic performance of a new-generation modular stent design for treatment of de novo coronary lesions.

The objectives of the Race Car study were to assess the safety and efficacy of the Medtronic AVE S670 stent, a new-generation stent with a modular design consisting of interconnected sinusoidal rings allowing improved flexibility with good conformability and scaffolding. A total of 285 stents were implanted in 267 patients with (un)stable angina pectoris who underwent angioplasty of a single de novo lesion in a native coronary artery with a diameter between 3.0 and 4.0 mm. Available stent lengths were 9, 12, and 15 mm. The primary endpoint was the 6-month restenosis rate. Secondary endpoints were device and procedural success and major adverse cardiac event (MACE)-free survival at 1 and 6 months. All patients received the study stents and no other stents were used (angiographic success: 100%). Eight patients experienced a MACE during hospital admission (Q-wave MI in 2, non-Q-wave MI in 4, TLR in 2). A procedural success was obtained in 97% of the patients. There were no additional events at 1 month. The clinical endpoints encountered at 6 months were Q-wave MI in 1, bypass surgery in 3, and repeat angioplasty in 25 (MACE-free survival: 86.5%). Quantitative angiographic results were the minimum lumen diameter increased from 1.05 +/- 0.32 before to 2.73 +/- 0.39 mm after stent implantation. At follow-up, the loss in diameter was 0.74 +/- 0.50 mm. The loss index was 0.45 +/- 0.31 and restenosis rate was 13.4%. This study has demonstrated that the S670 stent in patients with (un)stable angina pectoris requiring intervention of a single lesion has a low acute and 6-month major event rate and a low angiographic restenosis rate.

[Changes in QT dispersion during the exercise test in women with syndrome X]. / Zmiany dyspersji QT w czasie wysilku u kobiet z kardiologicznym zespolem X.

UNLABELLED: The aim of the present study was to examine the effect of exercise test on QT dispersion (dQT) and to compare the result in women with syndrome X with women with coronary artery disease and normal subjects. We examined 53 women in mean age 54.2 +/- 9.2 who were divided into groups: 20 women with one-vessel coronary artery disease (group I), 19 women with syndrome X (group II) and 14 healthy control women (group III). All subjects underwent a modified Bruce protocol exercise test and QT intervals were measured manually at rest and peak exercise. The value of dQT was calculated as a difference between the longest and the shortest measured value in each of the 12 ECG leads. Corrected QT (dQTc) dispersion was measured after the QT interval was corrected with Bazett's formula. There were no significant differences in rest values of dQT between groups but rest dQTc was significantly greater in group I and II then in group III. We observed significant increase in dQT and dQTc on peak exercise in group I and II when compared with group III. CONCLUSION: At rest dQTc is significantly greater in women with syndrome X and coronary artery diseases in comparison with control subjects. The exercise caused increase in the value of dQT and dQTc both in women with syndrome X and coronary artery disease. The value of dQT and dQTc makes impossible to differentiate between women with syndrome X and women with coronary artery disease.

[Atrial septal defect in adults--opinions, procedures and controversies]. / Ubytek w przegrodzie miedzyprzedsionkowej u doroslych--poglady, postepowanie i kontrowersje.

Atrial septal defect (ASD) accounts for 30-40% of congenital heart disease in adults diagnosed after the age of 40 and is after bicuspid aortic valve and mitral-valve prolaps the most common congenital cardiac malformation in adults. We have discussed current views on the pathological role of ASD in adults and controversies regarding its treatment. It is expected that increasing understanding of ASD pathophysiology, improved diagnostic methods and the possibility of transcatheter closure of interatrial defects will improve the treatment of patients with ASD.

Long-term outcome in patients with unstable angina treated by coronary balloon angioplasty.

UNLABELLED: Comparison of balloon angioplasty results in 472 patients with stable angina (SA) and 158 patients with unstable angina (UA) in 5-year follow-up is reported. Clinical success rate did not differ significantly, while periprocedural complications rate was higher in UA group (22.3 vs. 11.1%, P<0.001). During follow-up UA patients demonstrated higher: restenosis rate (48.5 vs. 30.4%, P<0.001), incidence of myocardial infarction (8.8 vs. 3.0%, P=0.004), although cardiac mortality did not differ significantly (2.2 vs. 1.6%). Reintervention rate in patients with unstable angina resultant from restenosis or significant artherosclerosis progression in coronary vessels, or originating from both of them, was also higher (53.7 vs. 34.1%, P<0.001). Event-free survival was significantly lower in UA patients (43.4 vs. 61.3%, P=0.02). The uni- and multivariate analysis proved that unstable angina was an independent risk factor in restenosis, re-intervention and cardiac events rate, despite perceptible differences in the baseline characteristics. Sub-group analysis of UA patients according to Braunwald classification revealed lower success rate and higher incidence of myocardial infarction during follow-up in post-infarction angina (class C), whereas new onset, no-rest angina (class I) had higher event-free survival in comparison with rest angina (classes II and III). CONCLUSIONS: UA patients treated by balloon angioplasty had higher periprocedural complications rate, as well as restenosis and re-intervention rate. Despite higher cardiovascular events rate during 5-year follow-up in UA group, survival rate in both groups was high and cardiac mortality did not differ significantly. Unstable angina constitutes a strong independent risk factor in adverse long-term outcome.

Predictive potential of noninvasive methods, inclusive of exercise SPECT Tc99m MIBI imaging, in recognition of high-risk patients with left main coronary artery stenosis.

The aim of the present study was to determine which clinical, exercise and perfusion variables can be instrumental in the identification of left main coronary artery. A multivariate model for prediction of left main disease was developed, based on a number of clinical, exercise and MIBI perfusion variables in two groups of patients. Group I consisted of 38 patients (30 men and eight women) with angiographically proven left main stenosis, while group II consisted of 41 patients (27 men and 14 women) with multivessel coronary artery diseases. A multivariate logistic regression analysis demonstrated that clinical variables including diabetes, hypertension, together with history of typical angina were the only independent predictors of left main stenosis. It was found that p value was 0.05 for hypertension, 0.01 for diabetes as well as 0.01 for the history of typical angina in clinical examination. No exercise or perfusion variables may be instrumental in prediction of left main stenosis, when considered in isolation. Myocardial perfusion by itself is therefore not deemed sufficiently specific to attempt its positive identification. High-risk patients with left main disease can be identified noninvasively by exercise perfusion imaging using a model based on the proposed logistic regression analysis with clinical variables.

[Percutaneous closure of atrial septal defect]. / Metoda przezskórnego zamkniecia ubytku w przegrodzie miedyprzedisonkowej.

Present state of knowledge about dynamically developing procedure of percutaneous atrial septal defect closure has been collected on the basis of the contemporary literature review. History of the method has been presented and a brief characteristics of implants used nowadays has been made with emphasis on their advantages and disadvantages. Technique and possible complications of the procedure have been described. Indications and contraindications to this way of treatment have been quoted. Comparison of percutaneous and surgical treatment has been made with indication of benefits following the less invasive character of percutaneous treatment.

[Clinical outcome in patients after single vessel PTCA with multiple stent implantation]. / Ocena chorych leczonych angioplastyka wiencowa i implantacja dwóch i wiecej stentów do jednej tetnicy.

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

Ischemic and reperfusive release of the endogenous purines and its influence on the myocardial viability during beta-adrenergic blockade.

The aim of this study was to estimate ischemic and reperfusive release of myocardial adenosine degradation products (MADP) during beta-adrenergic blockade and its relation to infarct size (IS) and viable myocardium size (VM). In a group of 24 shepherd-mongrel dogs, randomly assigned to a metoprolol (M-) and placebo-group (P-group), occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion with recombinant tissue plasminogen activator was performed. Regional myocardial blood flow (MBF) was measured by the radiolabelled microsphere technique. Blood samples from aorta and great cardiac vein were collected to evaluate the concentrations of MADP. The triphenyltetrazolium chloride perfusion and fixation technique was used for infarct size measurement. MBF in the area at risk decreased in both groups during ischemia, but it was significantly higher (p = 0.013) in M-group. Recanalization of LAD was associated with an increase in flow in postischemic vascular bed. MBF was significantly higher (p = 0.024) in P-group during late reperfusion. In M-group IS was smaller (p = 0.007) and VM was bigger (p = 0.007). The correlation between arterial adenosine concentration during early reperfusion and IS (p = 0.044, r = -0.588) or VM (p = 0.036, r = 0.607) in M-group was noted. Values of net MADP balances significantly increased during early reperfusion. The correlation between reperfusive net MADP balance and IS (p = 0.00005, r = 0.906) or VM (p = 0.016, r = -0.675) in M-group was observed. The amount of MADP released during reperfusion correlates with the IS and is inversely proportional to the area of VM. The endogenously released adenosine may have additional cardioprotective effect during beta-adrenergic blockade.

[Long term outcome in patients with and without restenosis after coronary angioplasty]. / Odlegle obserwacje u chorych z restenoza i bez nawrotu zwezenia po angioplastyce wiencowej.

Restenosis at dilatation site still constitutes a significant limitation of percutaneous coronary revascularisation. Majority of patients with restenosis are treated with repeat angioplasty, although its impact on long-term outcome is still little known > Very few studies focused on this issue bring rather discrepant results. The present study is aimed at assessing the impact of restenosis on long-term outcome in patients treated with coronary angioplasty. A group of 567 patients, who in the years 1987-1996 had successfully undergone percutaneous balloon coronary angio-plasty (PTCA) at our Clinic, was retrospectively divided into two groups: a group comprising 188 patients (33.2%) suffering from recurrent angina in whom restenosis had been established through control angiography, and a group comprising 379 patients (66.8%) who during the observation period exhibited no angina symptoms, or in whom the control angiography did not reveal restenosis. The restenotic patients were older (p = 0.007), more frequently exhibited symptoms of unstable angina upon PTCA (p < 0.0001), and there were also fewer smokers among them (p = 0.02). Furthermore, restenotic patients more frequently had multivessel and multilesion angioplasty (p = 0.025; p = 0.004, respectively). Restenosis after the first PTCA was treated by repeated angioplasty in 149 (79.3%) patients, 26 (13.8%) underwent CABG operation and 13 (6.9%) patients were treated pharmacologically without repeated revascularization. Within the 5-year observation period the mortality rate in both groups did not differ significantly (5.9% vs. 4.0%). Restenotic patients sustained myocardial infarctions more frequently (8.0% vs. 3.2%, p = 0.01), had significant atherosclerosis progression (37.2% vs. 15.0%, p < 0.0001), and were more frequently subjected to repeated interventions (37.2% vs. 15.0%, p < 0.0001), both PTCA (79.3% vs. 11.6% p < 0.0001) and CABG surgery (32.5% vs. 4.2%, p < 0.0001), as well as to multiple re-interventions (31.9% vs. 4.8%, p < 0.0001), in comparison with the non-restenotic ones. Analysis of functional status of patients assessed in compliance with the CCS criteria at the end of the observation period proved that significantly more non-restenotic patients did not experience angina, or experienced it rather sporadically (CCS Class 0 and 1). Logistic regression uni- and multivariate analysis proved that restenosis is an independent risk factor of myocardial infarction, reinterventions--also multiple ones--and cardiac events, although not mortality.

Long-term outcome of coronary balloon angioplasty in diabetic patients.

Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.

[Long-term results of coronary balloon angioplasty in various age groups]. / Wyniki angioplastyki wiencowej u chorych w róznych grupach wiekowych.

UNLABELLED: Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006). CONCLUSIONS: Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.

[Quality of life in diabetic patients with coronary artery disease treated with percutaneous coronary angioplasty]. / Jakosc zycia chorych z choroba wiencowa i cukrzyca leczonych za pomoca przezskórnej angioplastyki naczyn wiencowych.

UNLABELLED: Increased restenosis rate, higher incidence of coronary events, and, in some studies also increased mortality are observed during long-term follow-up in patients (pts) with diabetes mellitus treated with percutaneous coronary angioplasty. This is why some authors suggest that indications for PTCA in the group of diabetic pts should be significantly limited. The aim of our study was the estimation of clinical condition and quality of life in diabetic patients who underwent PTCA procedure in order to establish indications for percutaneous revascularisation in this group of pts. The study group consisted of 54 diabetic patients who were successfully treated with percutaneous coronary angioplasty in the period of 1987-1996. All pts were assessed clinically and quality of life was estimated on the basis of specially designed questionnaire. During mean 5-year follow-up 1(1.9%) patient died, 2 (3.7%) pts had acute myocardial infarction, restenosis was diagnosed in 25 (46.3%) pts. Repeated revascularisation was necessary in 27 (50%) pts. Significant clinical improvement was observed in the pts from the study group as compared to their clinical condition before the procedure (CCS 0 or I--61% vs 0%, p < 0.0001, III--9% vs. 39%, p < 0.0003, IV--1.9% vs. 22%, p < 0.001). The rate of pts who were employed did not change in consequence of successful PTCA procedure. The number of pts returning to work was equal to the number of patients receiving social benefits. Subjective improvement was declared by 87% of pts. Lack of angina pectoris episodes was reported by 52% of pts and in 35% of pts the number of angina pectoris episodes was significantly reduced. Better tolerance of physical activity was declared by 59% of pts, and 65% of the studied pts fully came back to their non-professional activities. Partial return to non-professional activities was possible for 24% of pts. Normal sexual activity was declared by 65% of pts. Only 9% of the studied pts experienced significant limitation in their sexual activity. PTCA met the expectations of 89% of pts while the number of negative opinions, i.e. the lack of subjective improvement, impaired quality of life, or disappointment with the results of the PTCA procedure did not exceed 13%. Significantly worse results of the selected parameters describing the quality of life were observed in the group of diabetic pts treated with insulin. CONCLUSIONS: PTCA improved quality of life in 60-90% of pts with diabetes mellitus, nevertheless, did not affect the employment status of successfully treated pts. Patients who needed insulin therapy had worse indicators of life quality, however thorough analysis suggest that PTCA can be advised as a method of treatment in the group of diabetic patients with coronary artery disease.

[Quality of life in patients after implantation of pacemaker type DDD]. / Samoocena jakosci zycia chorych po wszczepieniu rozrusznika serca typu DDD.

The aim of this study was to evaluate quality of life in pts with DDD pacemakers. The study group consisted of 343 pts (181 F, 162 M), mean age 66.7 +/- 2.5 y (19-92) in whom DDD pacemakers were implanted in the years 1992-1998 due to sick sinus syndrome (213 pts) or AV block (130 pts). Follow-up period was 111-2574 days, mean 924.58 +/- 550 days. The QOL assessment was based on the questionnaire prepared at our Center. The questionnaires were mailed to the pts. The significant improvement in overall well-being (p < 0.001), physical capacity (p < 0.005) and concentration (p < 0.025) was found as compared to the time before implantation. The incidence of syncopy decreased after implantation (p < 0.001). The pts complained of: limitation of arm moving (50.1%), anxiety for disturbances of PM function (41.4%), resignation from job (17.2%), restriction of sport activity (15.7%), necessity for follow-up visits (15.7%) and limitation of sex activity (10.2%). There were not significant differences in QOL between pts paced due to SSS or AV block. We found significant improvement in QOL after implantation of DDD pacemakers. The questionnaire-based assessment of QOL may be useful in management of DDD-paced pts.

[QT dispersion in patients treated with repeated percutaneous transluminal coronary revascularization]. / Dyspersja QT u chorych leczonych powtórna przezskórna rewaskularyzacja miesnia sercowego.

In this study the group of 30 patients with coronary artery disease (mean age 55 +/- 7 years) were examined. All patients underwent repeated percutaneous transluminal coronary revascularisation (rePTCR) due to coronary artery restenosis after primary coronary angioplasty. QT dispersion (dQT) and the corrected QT dispersion (dQTc), obtained applying Bazett's (dQTB) and Hodge's (dQTH) formulas, were measured before rePTCR and 7 days after rePTCR. Standard 12-lead electrocardiograms, 25 mm/s speed, were used. QT dispersion, defined as a difference between maximal and minimal QT intervals, was manually measured. The significant decrease of dQT after rePTCA was observed. Mean dQT before rePTCR was 88.67 +/- 29.09 ms and 64.00 +/- 28.96 ms after rePTCR (p < 0.0001). The changes of dQTc (dQTB, dQTH) were similar. Mean values of dQTB before and after rePTCR were 92.97 +/- 34.40 ms and 65.42 +/- 29.80 ms respectively, and mean values of dQTH were 94.90 ms +/- 37.31 ms and 70.98 ms +/- 32.85 ms. It was also noted that the frequency of appearance of dQT exceeding 80 ms significantly decreased after rePTCR (dQT exceeded 80 ms in 17 cases before rePTCR vs 5 cases after revascularisation). Increased QT dispersion can be a marker of the coronary artery restenosis.

Balloon positioning difficulties during nonsurgical septal reduction therapy in a patient with hypertrophic obstructive cardiomyopathy.

Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.

[Quality of life and working status in patients with coronary artery disease treated by percutaneous coronary angioplasty during long-term observation]. / Jakosc zycia i stan zatrudnienia chorych z choroba wiencowa leczonych przezskórna angioplastyka tetnic wiencowych w wieloletniej obserwacji.

UNLABELLED: Improvement in the quality of life is nowadays widely acknowledged as an important factor in assessment of the long-term outcome of the actually pursued treatment. Percutaneous transluminal coronary angioplasty (PTCA) has been used in the treatment of coronary disease in ca. 1/3 of patients. The present study aimed to assess the quality of life in 567 patients successfully treated by PTCA in the period 1987-1996. In the observation period spanning 2.5-12 years (5.5 years on average) 26 patients (4.6%) died. A specially designed questionnaire was sent out to the remaining 541 patients, in which they were asked to attempt a subjective assessment of their general health condition and physical fitness, as well as to comment on the quality of their family and social life following angioplasty. The filled-in questionnaire was returned by 447 patients (82.6%). Their functional status, assessed in compliance with the CCS criteria, was perceptibly improved after the procedure and at the end of the observation period 70.5% of patients had no significant coronary complaints. A durable improvement after PTCA was claimed by 85.7% of patients, for 38.2% the result of PTCA turned out to be much better than originally expected, while 47.9% admitted that the procedure actually complied with their expectations. No improvement whatsoever was reported by 11.8%, while 2.3% of patients claimed their condition to have deteriorated since. In their own assessment, normal sexual life after PTCA was still pursued by 63.1% of patients, though men appeared to be more active in that domain than women (68.0% vs. 44.7%, p = 0.0001). Notable improvement was reported by 15.2%, while deterioration was claimed by 17.2%; in both cases it was significantly more frequent in men (improvement 17.0% vs 8.5%, p = 0.042, deterioration 19.5% vs 8.5%, p = 0.012). Angioplasty had no impact on their social relations in 78.8% of patients, while 21.2% of them are commonly perceived as the disabled persons. The need for psychotherapy (counselling) was expressed by 15.9%. The analysis of the key factors determining the actual quality of life in patients, carried out in the sub-groups, did not yield significant differences between the patients with stable and unstable angina, patients below and over 50 years of age, patients with complete and incomplete revascularisation, nor in patients who experienced or not, cardiac events during the follow-up. The significant differences between men and women were encountered only with respect to their sexual life. Diabetics in comparison with non-diabetics significantly more frequently reported improvement in their sexual life, full resumption of their non-occupational activities, generally showed more appreciation for the overall outcome of the PTCA procedure. Diabetics much less frequently experienced improvement in their general physical fitness, generally regarded the need for regular medical check-ups as a hindrance, as well as were more frequently perceived as the disabled persons. The working status of the patients after angioplasty failed to improve, however, as nearly half of them, despite the successfully completed procedure, was granted disability pensions or took advantage of the voluntary retirement schemes. Only 7.2% of the non-working patients well within their statutory employment age successfully returned to their employment, although not on a full-time basis. Patients who had completed their primary or secondary education were found to leave their employment twice more frequently than the ones with academic education. Similarly, patients living in the rural areas or in small towns (less than 40.000 inhabitants) left their employment twice more frequently than the ones living in major cities. CONCLUSIONS: Both the functional status of patients and the majority of the analysed factors determining the quality of life--in the subjective assessment of those patients--improved significantly after a successful PTCA. This improvement is irrespective of the patients' age, symptoms of unstable angina during the procedure, extensiveness of revascularisation as well as cardiac events during the follow-up. Nearly half of the working patients tend to leave their employment after a successful percutaneous revascularisation, while the non-working patients are seldom prompted to resume their employment by the successful procedure. Patients with academic education, living in major cities, are usually found to resume their original employment most frequently.

The quality of life after aortic valve replacement with homografts or prosthetic valves.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the quality of life in patients after homograft or prosthetic aortic valve implantation. Evaluation was based on clinical and echocardiographic examinations, and on analysis of data from patient questionnaires. METHODS: Patients undergoing either homograft (HV, n = 220) or prosthetic (PV, n = 220) aortic valve replacement were investigated. The patients groups were similar in age, sex, follow up period, risk factors and type of heart defect, and did not demonstrate any dysfunction of the replacement valve. RESULTS: During both pre- and postoperative periods, no significant inter-group differences were identified with regard to the occurrence of retrosternal pain, dyspnea, palpitation, fear reaction and circulatory efficiency based on NYHA classification, and self-evaluation of physical activity assessed by patient questionnaires. The majority of patients in both groups noticed on increase in their quality of life and physical activity. The reduced sexual activity (50%) and fear reaction (30%) in both groups did not correlate with their improved sense of well-being. Up to 14.6% of PV patients did not accept the implanted valve, and 65 (29.5%) would have preferred an HV, despite the need for reoperation. Following surgery, 21% of HV patients resumed work, compared with only 7.7% of PV patients. The frequency of claims for disability pension after surgery did not correlate with the considerate clinical and subjective improvement. CONCLUSIONS: In patients receiving either homograft or prosthetic valves, the subjective evaluation of life quality is comparable with the clinical evaluation, though the homograft valve was better accepted than its prosthetic counterpart.

Ambiguity of morphological criteria of myocarditis in cardiac biopsy specimens.

Myocarditis is diagnosed when leukocytic infiltrate is accompanied by myocyte degeneration or necrosis. Endomyocardial biopsy is evaluated as the main diagnostic method. The purpose of the present study was to examine the individual elements of a histological picture and specify morphological criteria of diagnosing myocarditis in cardiac biopsy. The Dallas criteria were the point of reference. In the cardiobiopsies from 70 patients with clinically suspected myocarditis or congestive cardiomyopathy an active myocarditis was found in 19 cases, significantly more frequently in the group clinically classified as having myocarditis. Contraction bands, endocardial changes and vasculopathy were more frequent in cases histologically classified as active myocarditis than in borderline myocarditis. In our opinion the Dallas criteria include certain ambiguities concerning mainly differences of individual types and phases of myocarditis as well as their relations to congestive cardiomyopathy. The sensitivity and specificity of the diagnosis are related both to methodological limitations (material selection) and difficulties occurring mainly at the level of perception, evaluation and interpretation of changes. It is possible to improve the efficacy of cardiac biopsy in diagnosing myocarditis if a new techniques better revealing myocyte damage and more unequivocally determining the cellular composition of the stroma have been developed.