Absolute value of the difference of Tl-201 uptake between redistribution and rest is a specific marker of myocardial viability.

Although Tl-201 rest redistribution SPECT is widely used to assess myocardial viability, there is no agreement on the best prognostic marker of left ventricle contraction improvement after revascularization. More recent data suggest that not only rest or redistribution uptake but also reverse redistribution patterns may serve to indicate the viability of myocardium. The aim of this study was to define criteria (which include reversibility and reverse redistribution) for viability testing and prediction of functional outcome in Tl-201 rest redistribution SPECT. Twenty-five patients with left ventricle dyssynergy were studied before and after revascularization with Tl-201 SPECT and echocardiography. Perfusion and contractility was assessed in a 16-segment model of the left ventricle. Out of 400 left ventricular segments, contraction disturbances of various degree of intensity (hypokinesis, akinesis and dyskinesis) were found by echocardiography in 107 segments. Revascularization was performed in 97 segments. In 57% of the segments, improvement of contraction was observed after PTCA or CABG. Perfusion was analysed in the segments between segments with and without contraction improvement. In discriminant analysis, only the modulus of difference between rest and redistribution study > or = 10% was the common parameter for hypo-, a- and dyskinetic segments to predict the functional recovery of left ventricle (LV) with the specificity of 93% and sensitivity of 78%. The modulus of segmental quantitative difference between redistribution and rest image is a new parameter adding specificity to Tl-201 rest redistribution SPECT in prediction of recovery of left ventricle function.

[Norms of arterial blood pressure for 24 hours based on biological activity]. / Normy cisnienia tetniczego krwi dla 24 ABPM oparte na podstawowej aktywnosci biologicznej.

So far there is no unambiguous universally accepted standards for 24 ABPM. Aim of this study was to establish standard values of systolic and diastolic blood pressures, taking into account minimal night values, corresponding with basic biological activity. 1204 patients were tested. In 707 of them, (mean age 42.5 +/- 14.7 years), arterial hypertension was recognized. Basic on our results we determined borderline values (112/69 mmHg) which are diagnostic for arterial hypertension. Those norms eliminate influence of environmental factors on values of blood pressure. They correspond with homeostasis in hypertensive patients.

[Examination of skin microcirculation with laser-Doppler flowmetry in patients with essential hypertension]. / Wykorzystanie wlosniczkowej przeplywometrii laserowej do oceny stanu mikrokrazenia skórnego u chorych na nadcisnienie tetnicze samoistne.

The estimation of microcirculatory parameters in patients with essential hypertension and in normotensic control group was the aim of this study. The study group consisted of 14 patients with essential hypertension confirmed by 24-hours ABP. 10 healthy patients served as control group. The flow in the skin microcirculation was measured by laser-Doppler flowmeter (PF-3, PERIMED) on dorsal part of the palm. Microcirculatory indices were registered in resting conditions, during one-minute occlusion reaction and during reactive hyperemia. The following indices were calculated: resting flow, biological zero, maximal flow, time to maximal flow, ratio of maximal to resting flow, ratio of resting flow to biological zero and ratio of maximal flow to biological zero. Skin microcirculation was highly disturbed in patients with essential hypertension. It was expressed by significantly higher biological zero and longer time to maximal flow.

[Influence of trimetazidine on echocardiography parameters and free radical stress index in coronary artery disease and end-stage renal failure patients treated by hemodialysis: preliminary communication]. / Wplyw trimetazydyny na wybrane wskazniki echokardiograficzne i wskaznik stresu oksydacyjnego u chorych na chorobe wiencowa i z nieodwracalna niewydolnoscia nerek leczonych hemodializami--doniesienie wstepne.

The aim of the study was the assessment of the influence of trimetazidine (TMZ) on echocardiography parameters and oxidative stress markers in hemodialyzed patients with coronary artery disease. The studies were carried out in 9 patients group before and after 3 months of TMZ treatment in doses 3 x 20 mg. Additionally we measured MDA concentration in the blood, as a oxidative stress marker, before and after 2 and 3 months of TMZ treatment. At the start of the study impairment of relaxation as a sign of diastolic dysfunction was detected. This abnormality persisted up to the end of the study. After 3 months of TMZ treatment we observed elevation of ejection fraction from 59.17 +/- 5.99 to 65.33 +/- 8.7% (p = 0.05). Also occurred statistically significant decrease in MDA level after 2 (0.674 +/- 0.029 vs 0.627 +/- 0.034; p < 0.001) and 3 (0.674 +/- 0.029 vs 0.567 +/- 0.063 mumol/L; p = 0.001) months of TMZ treatment. Significant improvement of the left ventricular function and decrease of MDA levels in the blood might be due to intracellular mechanisms of TMZ activity. There were no side effects of the drug in hemodialyzed patients.

[Late cellular potentials in patients after myocardial infarction--a result of left ventricular diastolic disfunction?]. / Pózne potencjaly komorowe u chorych po zawale serca--wynik uposledzenia funkcji rozkurczowej lewej komory?

The link between left ventricular dysfunction and arrhythmogenesis is commonly known. However, so far, only the systolic left ventricular dysfunction has been evaluated. Because of the controversial results of those studies, we decided to assess if is there a link between late potentials (LP) and left ventricular diastolic dysfunction. Our material consisted of 56 patients: 11 women and 45 men, mean age was 61.12 +/- 10.07 years. Signal averaged ECG and ECHO were performed in each patient, 2-3 months after myocardial infarction. For high pass filter of 40 Hz, LP were defined as 2 or 3 abnormal SAECG variables (the averaged QRS > 114 ms, the low amplitude signal duration LAS > 38 ms and root mean square voltage of the terminal 40 ms RMS40 < 20 microV). During ECHO study, we assessed E and A waves E/A ratio, left ventricular end-diastolic volume (LVEDV), ejection fraction (EF), acceleration (AT) and deceleration times (DT). The patients were divided into 2 groups: group I-30 patients LP positive and group II-26 patients LP negative. There were no significant differences between the groups in terms of age, EF, and heart rate. We presented significant differences between group I and II in terms of E wave velocity (0.75 +/- 0.19 vs 0.64 +/- 0.19 p < 0.03) E/A ratio (2.13 +/- 1.56 vs 1.0 +/- 0.5 p < 0.05) respectively. We did not confirm significant differences as regards A wave velocity, AT, isovolumetric time (IVRT) and LVEDV between both tested groups. In group I we revealed a significant correlation between E wave (r = 0.45), E/A ratio (r = 0.62), AT (r = -0.42) E/A ratio (r = 0.56), DT (r = 0.55) and QRS, as well as DT and LPD (r = 0.40) and between IVRT and RMS40 (r = -0.43). The results of our study suggest that in patients after myocardial infarction: 1/incidence of LP depends on the degree of left ventricular filling pattern like in impaired relaxion, quite well correlated with filtered QRS time 3/in LP positive patients there was predominance of restrictive left ventricular filling pattern, quite well correlation with RMS40 amplitude.

[Frequency of paroxysmal atrial fibrillation and parameters of averaged atrial signal]. / Czestosc napadów migotania przedsionków a parametry usrednionego sygnalu przedsionkowego.

The aim of the study was to evaluate the importance of time and frequency domain analysis of P-wave signal averaging, left atrium size measured echocardiographically and time of P.-wave assessed in II lead of standard ECG in patients with different frequency of atrial fibrillation events. The material consisted of 110 pts (81 men and 29 women), mean age 60.44 +/- 10.73 with atrial fibrillation events concomitant coronary heart disease and/or primary hypertension documented in standard ECG or Holter monitoring. The positive correlation, statistically significant between the frequency of atrial fibrillation events and the time of filtered P-wave vector, the time of filtered P-wave in X, Y, Z leads and differences between times of filtered P-wave vector and times of P-wave in II ECG lead was confirmed. Additionally the negative correlation, statistically significant between frequency of atrial fibrillation events and RMS10, RMS20 and RMS30 was confirmed. There was no correlation between frequency analysis of P-wave averaging or left size and frequency of atrial fibrillation events.

[Perindopril in monotherapy of primary hypertension--6 month observation]. / Peryndopryl w monoterapii nadcisnienia tetniczego samoistengo--obserwacja 6-miesieczna.

UNLABELLED: We evaluated effects of perindopril (Prestarium-SERVIER) in the treatment of the primary hypertension in 41 patients (mean age 41.6) in the I or II degrees WHO using 24 ambulatory blood pressure measurement and echocardiography. Investigation were performed before and after 3 and 6 months of the treatment. Initially 4 mg of perindopril was given and individually was increased after 3 months to 8 mg according to 24 ambulatory blood pressure measurement results. We obtained significant decrease of blood pressure in 3 (134.6/86.6 mm Hg) and in 6 (135/88, 9 mm Hg) months of treatment in comparison to baseline values (141.8/91.1 mm Hg), decrease of left ventricular mass to 244.4 g in 3 and 248.8 g after 6 months (baseline 258.5 g), as well as index of left ventricular mass, wall thickness and left ventricular end diastolic volume. There was no significant differences in: ejection, heart rate, left ventricular inflow on the successive investigations. Good effect of perindopril we observed in 31 patients (75.6%) after 6 months of treatment. We did not observe any serious side effects of perindopril. CONCLUSION: Perindopril in treatment hypertension effectively reduces the level of blood pressure (systolic, diastolic and mean) without any effect on heart rate. Prestarium reduces left ventricular mass, intraseptal wall thickness and left ventricular end diastolic volume. There is no influence on inflow to the left ventricle as well as on ejection fraction.

[Echocardiographic evaluation of cardiac structures in patients with rheumatoid arthritis]. / Ocena echokardiograficzna struktur serca u chorych na reumatoidalne zapalenie stawów.

Since heart lesions were found at autopsy in 55-60% of rheumatoid arthritis patients, we decided to assess echocardiographically their clinical significance. The study comprised 100 consecutive patients with rheumatoid arthritis (77 females and 23 males) of the mean age 55.7 +/- 12.5 yrs (range 18-83 yrs) and the disease duration of 8.3 +/- 8.0 yrs (range 1-35 yrs). The control group consisted of 100 consecutive age and sex matched patients admitted to university hospital. All the patients underwent echocardiographic examinations in apical and parasternal projections. The activity of the rheumatoid process, the severity of articular lesions, the presence of extraarticular sings as well as HLA DR and DQ antigens were determined clinically and with laboratory tests. Twenty six patients with rheumatoid arthritis had pericardial effusion, 10 revealed the sings of chronic pericarditis, in the control group 4 and 0 respectively (p = 0.001 and p = 0.025). No difference was shown in the wall contractions disturbances, size of the cardiac cavity, or thicknesses of the interventricular septum or posterior wall. In 3 rheumatoid arthritis patients, a valvular heart disease was diagnosed, this number was not significantly different from that in the control group (2 patients). There was no correlation between the lesions observed in the heart and the rheumatoid process activity estimated with clinical and laboratory indices.

24-h ECG monitoring in patients with rheumatoid arthritis.

Although the main cardiac complication in patients with rheumatoid arthritis is subclinical pericarditis, mononuclear cell infiltrations into myocardium may cause cardiac arrhythmias and conduction defects. In order to examine these problems we evaluated 70 patients (53 women and 17 men) aged 18-83 years (average 56.7 +/- 11.2) with classic or definite rheumatoid arthritis, according to diagnostic criteria. Duration of the disease was 1-35 years (average 8.7 +/- 8.4). The control group comprised 70 patients admitted to hospital with degenerative joint disease, a duodenal ulcer, or who required treatment for ophthalmological or laryngeal reasons; these patients were matched for sex and age. In all patients standard 12-lead ECG investigations were performed, as well as 24-h ECG monitoring, using an Oxford Medical System device with two precordial leads CM5 and CS2, according to the Holter method. We analysed heart rate, conduction disturbances, and occurrence of arrhythmias, on the basis of generally assumed ECG criteria. Cardiac arrhythmias were found in 50% of patients with rheumatoid arthritis, and their occurrence was similar to that in the control group. Observed arrhythmias were independent of the progression of arthritis, the type of treatment administered, the familial occurrence of arthritis, the presence of manifestations pertaining to organs, the presence of rheumatoid factor, the stage of the disease according to Steinbrocker, or the presence of immune complexes in serum and HLA Dr antigens, which are regarded as fundamental in the pathogenesis of rheumatoid arthritis.

[Ventricular arrhythmias and the ATc index in patients with ischemic heart disease]. / Komorowe zaburzenia rytmu serca a wskaznik QTc u chorych z choroba niedokrwienna serca.

In this multicenter study a group of 1,011 patients (233 females and 778 males, aged 23-68 years, mean 53) with ischaemic heart disease was included. Only nitrates, nifedipine and diuretics were administered during the investigation. Presence of other chronic disease excluded the patients from study group. In all patients a standard 12-lead electrocardiogram was obtained, from which the QT interval was measured, and its corrected value according to the Bazett's formula calculated [formula: see text] values greater than 440 ms were regarded to be abnormal. A 24-hour ecg ambulatory monitoring was also performed in each patient, and the detected ventricular ectopic activity was classified using the Lown's criteria. Mean QTc values were compared between each class of ventricular arrhythmia. No significant differences were disclosed. All the means were below 440 ms. Also the percentages of patients with a prolonged QTc were similar for all Lown classes of arrhythmia. The patients were then divided into two larger groups: Those with low grade (class 0-2) and high grade (class 3-5) arrhythmia. The portion of patients with the pathologic QTc was not significantly different (21% vs. 28%, NS). Such incidence of QTc prolongation was described for clinically healthy population. Since a 24-hour ecg fails to disclose the entire spectrum of arrhythmia in each individual, the fraction of patients with documented VT/VF in the past was analyzed separately. This subgroup was characterized by more frequent occurrence of QTc prolongation than other patients (35% vs. 20%, p = 0.043). Thus, no firm relationship was found between QTc prolongation and ventricular arrhythmias, but increased QTc favoured the occurrence of VT/VF.

[Effects of antiarrhythmic drugs on some echocardiographic parameters of left ventricular function in patients with ischemic heart disease]. / Wplyw leków przeciwarytmicznych na niektóre echokardiograficzne wskazniki czynnosci lewej komory u chorych z choroba niedokrwienna serca.

This study was performed to evaluate the effects of antiarrhythmic drugs on left ventricular function in 843 patients with ischaemic heart disease and ventricular arrhythmias (Lown classes 2-5). Rhythm abnormalities were observed by ambulatory electrocardiographic monitoring before and after 2-weeks of antiarrhythmic therapy. Haemodynamic variables such as cardiac output (CO), ejection fraction (EF), stroke volume (SV), and ratio of myocardial contractility (RMC) were derived from the cross sectional echocardiography. Efficacy of the applied drugs was 42-71%. Of these antiarrhythmic agents only propranolol caused the deterioration of left ventricular performance, measured by CO; in mono-therapy propranolol produced significant changes (p less than 0.05), in combination with amiodarone--at point of significance. Mexiletine produced significant improvement in EF and SV (p less than 0.05). There were no significant changes in haemodynamic parameters after treatment with the other drugs.

[A case of primary pulmonary hypertension in a patient with Raynaud's disease]. / Przypadek pierwotnego nadcisnienia plucnego u osoby z choroba Raynauda.

A case of a 50-year female patient with Raynaud's disease is presented. The primary pulmonary hypertension accompanying the underlying condition suggests that the excessive contractibility of the vessels, typical for the Raynaud's disease, may play a role in the etiology of the primary pulmonary hypertension.