The influence of obesity on progression of coronary arteriosclerosis and clinical course after ST elevation acute myocardial infarction treated with primary coronary interventions.

PURPOSE: Evaluation of influence of obesity on the coronary atherosclerosis development and clinical outcome in patients with STEMI treated by PCI with BMS implantation. MATERIAL AND METHOD: 82 patients (64 men) treated with PCI within 6 hours from 1st STEMI. Three groups of pts were formed according to BMI. Based on coronary angiography number of significant stenoses (NSS), number of stenosed coronary arteries (NSA), and sum of significant stenoses (SSS) were calculated. Echocardiography examination was performed 3 days and 6 months after STEMI. Serial evaluation of TnI, CK, CKMB was performed after admission, and serum BNP was assessed after 2 days, 1 and 6 months after STEMI. RESULTS: Obese patients revealed higher values of NSA, NSS and SSS than patients with normal BMI and overweight. There were no differences of BNP, maximal values and AUC of CK, CKMB, TnI and echocardiographic parameters between all groups whereas decrease of BNP during follow-up correlated with BMI. CONCLUSIONS: Results of our prospective study indicate that in obese patients, there is a significantly greater number of atherosclerotic lesions in coronary arteries found during PCI, as compared to those with normal body weight or overweight. We proved that overweight and obesity did not result in significantly greater damage to the myocardium and left ventricular dysfunction, both in the acute phase and 6 months after myocardial infarction treated with primary coronary intervention, as compared to those with normal body weight. In addition correlation was found between BNP concentration profile and body mass index in the 6-month follow-up after STEMI treated with PCI and bare metal stent implantation.

[Comparison of clinical status and long-term outcome of patients with angina pectoris and normal coronary vessels in coronary angiography or insignificantly narrowed coronary arteries]. / Porównanie obrazu klinicznego i rokowania odleglego chorych z dusznica bolesna i z prawidlowymi tetnicami wiencowymi w koronarografii oraz chorych z przysciennymi zmianami miazdzycowymi.

UNLABELLED: Among patients investigated with coronary angiography because of effort chest pains, 8-30% are found to have insignificantly narrowed coronary arteries. In this group there are patients with angiographically normal coronary arteries and patients with hemodynamically insignificant atherosclerotic plaques. The aim of this study was to compare clinical status and long-term outcome of patients with effort angina whose epicardial coronary arteries were angiographically normal (Group 1) and patients with luminal diameter stenoses of maximum 30% (Group 2). Between III'91 and IV'97 we identified 230 patients who underwent coronary angiography in the Department of Coronary Artery Disease in Cracow. At the end of the follow-up the patients were asked to complete the self-report questionnaires which evaluated the course of the disease after discharge from the Department and present symptoms. On the basis of the medical records from the hospitalization in the Department and returned questionnaires data of 142 patients (Group 1: 89 patients, 46 men and 43 women, mean age 48.10 +/- 9.2 years; Group 2: 53 patients, 36 men and 17 women, mean age 52.51 +/- 9.6 years) were analyzed. Group 2 patients were older (p = 0.007), with higher prevalence of men (p = 0.05). The mean follow-up was 3.47 +/- 1.7 years for Group 1 and 2.85 +/- 1.7 years for group 2 (p = NS). Left ventricle contractility was normal in both groups. The occurrence of atherosclerosis risk factors was more frequent in Group 2 patients and didn't change significantly over the observation period. There were no deaths or new myocardial infarctions during the observation. Unstable angina occurred in 4 (2.8%) of patients. 33 patients (23.2%) reported hospital treatment for chest pain with mean frequency 0.13 +/- 0.3 hospitalizations/year in Group 1 and 0.09 +/- 0.17 in Group 2 (p = NS). Before coronary angiography this index was significantly higher -0.57 +/- 0.8 hospitalizations/year in group 1 and 0.51 +/- 0.7 in group 2 (p < 0.001 for both groups). Anginal symptoms improved significantly over the observation period. Before coronary angiography majority of patients (60.5% Group 1 patients and 58.3% of Group 2 patients) defined their angina as severe comparing to respectively 7.1% and 2.1% of patients at the end of follow-up (p < 0.05 for both groups). Only 8 (5.6%) of patients remained entirely asymptomatic at the end of the study. During the observation 7 (4.9%) of patients returned to work while 30 (21.1%) of patients retired for medical reasons out of which 25 (17.6%) were due to heart disease. During the follow-up there were no differences between the groups in the professional activity of patients. Group 2 patients were receiving more cardiac medications (mean 2.63 +/- 0.8 vs 2.18 +/- 0.9 at the discharge from the Department; p. = 0.05 and mean 2.52 +/- 0.9 vs 2.02 +/- 1.0 at the end of follow-up; p = 0.04). Group 2 patients were more frequently taking nitrates (86.3% vs 53.7% at the discharge from the Department; p < 0.001 and 77.1% vs 60.9% at the end of the study; p = 0.05) and diuretics. CONCLUSIONS: 1. During follow-up (mean 3.4 years) there were no differences between the groups in the presence of symptoms, frequency of hospitalizations and occurrence of acute coronary events. 2. In both groups severity of anginal symptoms and frequency of hospitalizations decreased significantly. 3. The persistence of cardiac symptoms might have been caused by the presence of atherosclerosis risk factors during the follow-up.

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.

[Efficacy and tolerance of trimetazidine, a metabolic antianginal, in combination with a hemodynamic antianginal in stable exertion angina. TRIMPOL I, a multicenter study]. / Efficacité et tolérance de la trimétazidine, antiangoreux métabolique, en association avec un antiangoreux hémodynamique dans l'angor d'effort stable. TRIMPOL I une étude multicentrique.

OBJECTIVE: Assess the antianginal and anti-ischemic effect of trimetazidine in patients with stable exercise-induced angina insufficiently controlled with conventional antianginal drugs. PATIENTS AND METHODS: The study population included patients with coronarographically documented stable exercise-induced angina and no other serious concomitant condition. For inclusion, patients had to have two comparably positive treadmill exercise tests. Conventional antiangina drugs (long-acting nitrate derivatives, beta-blockers or calcium antagonists) were continued as was any other therapy having no effect on the ECG ST segment. The patients were given a 4-week regimen of trimetazidine (20 mg t.i.d.) after the second positive treadmill test and final inclusion. At the end of this period, a final exercise test was performed. The study population included 700 patients (mean age 54 +/- 8.4 years, range 32-71 years, 615 men, 85 women) who completed the entire treatment protocol. RESULTS: The main findings observed after 4 weeks of treatment with trimetazidine were: significant lengthening of the total duration of exercise (486.6 s versus 443.7 s, p < 0.01)), increase in total work (10.6 METS versus 9.4 METS, p < 0.01), significant lengthening of delay to 1 mm ST depression (389.9 s versus 337.8 s, p < 0.01) and of the delay to onset of angina (450.3 s versus 251.7 s, p < 0.01). The other results were a significant reduction in the number of daily episodes of angina (2.47 versus 3.66, p < 0.01) and a reduction in mean use of complementary trinitrine (1.8 versus 2.94, p < 0.01). CONCLUSIONS: Four weeks of treatment with trimetazidine in combination with conventional antiangina drugs leads to a longer delay to development of 1 mm ST depression (ischemia threshold), significant lengthening of total duration of treadmill exercise, increased total work, and longer delay to angina theshold. Clinically, there was a reduction in the mean number of episodes of angina and a reduction in the use of trinitrine.

The antiischemic effects and tolerability of trimetazidine in coronary diabetic patients. A substudy from TRIMPOL-1.

Diabetes mellitus, a disease with a wide prevalence, has major cardiovascular effects, being a risk factor for the development of ischemic heart disease and congestive heart failure. The aim of this open, multicenter study was to assess the antiischemic efficacy and tolerability of trimetazidine, a metabolic agent acting at the myocardial mitochondrial level, in diabetic patients with stable effort angina treated previously with a single conventional antianginal drug. Fifty diabetic patients (mean age 58 years) with proven coronary artery disease, stable effort angina for at least 3 months, and positive, comparable results of two initial treadmill exercise tests separated by a 1-week interval were included in the study. They continued their conventional antianginal monotherapy with a long-acting nitrate, beta-blocker, or calcium channel blocker. After stabilization, 4-week therapy with trimetazidine, three times daily, 20 mg was initiated in combination with previous treatment. The results showed a significant improvement in exercise tolerance (440.2 vs. 383.2 s; P < 0.01), time to 1-mm ST-segment depression (358.3 vs. 301.6 s; P < 0.01), time to onset of anginal pain (400.0 vs. 238.3 s; P < 0.01), and total work (9.39 vs. 8.67 metabolic equivalents, P < 0.01). Maximal ST-segment depression was attenuated compared with baseline (1.82 vs. 1.91 mm). Other findings included a significant decrease in the mean frequency of anginal episodes (3.06 vs. 4.79 per week; P < 0.01) and in mean nitrate consumption (2.29 vs. 4.2 doses/week). These results suggest that trimetazidine may be effective and is well tolerated as combination therapy for diabetic coronary artery disease patients uncontrolled with a single hemodynamic agent.

[Severity of angina pectoris and coronary angiographic imaging]. / Nasilenie dusznicy bolesnej a obraz koronariograficzny naczyn wiencowych.

The aim of the study was to evaluate commonly accepted assumption that more extensive coronary lesions correspond to more severe coronary symptoms. 300 consecutive patients with coronary artery disease (74 women and 226 men) admitted to Department of Coronary Disease in 1993/94 were studied. Coronary symptoms were assessed according to the Canadian Cardiovascular Society (CCS) classification of angina pectoris. Anatomic lesions revealed by angiography were classified as one, two or three vessel disease and also with use of Califfs jeopardy score (0-12 points) which is the simple and more precise method of estimating the amount of myocardium at risk. We found significant but rather weak correlation between severity of coronary symptoms (CCS) and angiographic findings (jeopardy score): (r = 0.16, p = 0.07). It was shown that there is the significant correlation between symptoms severity and anatomic lesions revealed by angiography. 17% of patients in spite of the extensive coronary atherosclerosis (10-12 points according to Califf) were almost asymptomatic (I class CCS). It is emphasized that one third of the patients had no critical stenosis however 51% of them presented severe coronary symptoms (III, IV class CCS).

[Angiogenesis and its clinical significance]. / Angiogeneza i jej znaczenie kliniczne.

This study collects past and recent data about neovascularization process and angiogenic factors. Development of the collateral circulation in the heart in response to gradual and progressive coronary artery occlusion was described. Pharmaceutical and surgical methods of angiogenesis induction was discussed. Importance of angiogenic process in many both physiological and pathological situations was noticed. It was pointed out that discovery and cloning of angiogenic cytokines maybe very useful in future treatment.

[Diagnostic difficulties in a 32-year old patient with cardiac tamponade]. / Trudnosci diagnostyczne u 32-letniego chorego z tamponada serca.

At present the most frequent cause of cardiac tamponade is neoplasma. A case of a 32-year-old male with recurrent cardiac tamponade caused by pericardium mesothelioma is described. Despite advanced neoplastic process in the pericardium, pleura and mediastinum, neither radiologic examinations of the chest, echocardiography, nor repeated cytologic examination of the pericardial exudate, could establish the etiology of the tamponade. Only after a pericardial window had been performed was it possible to: 1) establish the diagnosis and introduce causal treatment; 2) prevent recurrence of the tamponade; 3) perform cytoreduction of the tumor. It seems that in cases of chronic exudative pericarditis of unknown cause it is proper to perform an early pericardial window as a diagnostic and therapeutic procedure.