Obesity, ultrasound indexes of fat depots and lipid goal attainment in patients with high and very high cardiovascular risk: A novel approach towards better risk reduction.

AIM: Our aim was to assess the attainment of primary (low density lipoprotein cholesterol; LDL-C) and secondary (non-high density lipoprotein cholesterol; non-HDL-C) lipid therapeutic goals in relation to obesity, clinical measures of adiposity and ultrasound indexes of fat depots, including the novel index of periarterial adipose tissue (PAT): carotid artery extra media thickness (EMT). METHODS AND RESULTS: High and very high cardiovascular (CV) risk patients (n = 420; F/M: 34/66%; age: 61.2 ± 7 years) with prior statin treatment (≥ 18 months) were enrolled into this cross-sectional study. All patients had a detailed assessment with several anthropometric measures and ultrasound indexes of fat depots indexed to BMI: abdominal (Intra-abdominal Fat Thickness; IAT and Pre-peritoneal Fat Thickness; PreFT), paracardial (Epicardial Fat Thickness; EFT and Pericardial Fat Thickness; PFT) and the new index corresponding to PAT (carotid EMT). Lipid goals attainment in the study group was as follows: 34% (LDL-C goal), 39% (non-HDL-C goal) and 35% (both LDL and non-HDL-C goals). Among ultrasound indexes, patients with both lipid goals attainment revealed significantly lower carotid EMT/BMI (LDL-C goal: 25.2 ± 4.2 vs 27.5 ± 4.1, p < 0.01 and non-HDL-C goal: 26.1 ± 4 vs 27.7 ± 4.2, p < 0.01) and IAT/BMI (LDL-C goal: 2.35 ± 0.66 vs 2.51 ± 0.71, p = 0.02 and non-HDL-C goal: p = ns) compared to individuals without goals achievement. Moreover, lipid goals attainment was associated with both measures: carotid EMT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05) and IAT/BMI (LDL-C goal: r = -0.2, p < 0.05 and non-HDL-C goal: r = -0.2, p < 0.05). Multivariable regression analysis showed also independent association between carotid EMT/BMI and both goals achievement: LDL-C (p = 0.01) and non-HDL-C goal (p = 0.01). Other fat depots indexes (EFT, PFT and PreFT) failed to provide additional data. CONCLUSION: Contrary to overall obesity and most clinical measures of adiposity, carotid EMT and abdominal IAT, but not other ultrasound indexes of fat depots revealed associations independent from BMI with lipid goal attainment and may help identify patients requiring more aggressive lipid management.

A patient with abnormalities of the coronary arteries and non-compaction of the left ventricular myocardium resulting in ischaemic heart disease symptoms.

Left ventricular non-compaction (LVNC) is a rare cardiomyopathy that results from unsettled embryogenesis of myocardium. It is morphologically characterised by the presence of non-compacted, this is hypertrabeculated, myocardium of the left ventricle with deep endocardial recesses. The clinical spectrum of symptoms is very wide - from asymptomatic patients through the cases of heart failure to the patients requiring heart transplantation. The diagnosis is most frequently based on the echocardiography. LVNC is often coexisted with other heart defects and coronary artery abnormalities. We described a case of a 58-year-old man with LVNC and coronary artery anomalies.

Extra-media thickness and epicardial fat: Comparison of a novel carotid artery ultrasound index and a well-established cardiac magnetic resonance fat quantification method.

BACKGROUND AND AIM: Epicardial and pericardial fat are well-established surrogate markers of cardiovascular diseases and complications. Extra-media thickness (EMT) is a novel ultrasound index corresponding to arterial adventitia and adipose tissue. We aimed to evaluate the association between carotid EMT and epicardial fat (EF) and pericardial fat (PF) and their relation to cardiovascular risk and metabolic syndrome (MS). METHODS AND RESULTS: One hundred consecutive patients (age: 51.7 ± 15.4 years; males 70%) scheduled for cardiac magnetic resonance (CMR) were prospectively included in the study. Anthropometric parameters, CMR indices of EF and PF, both common carotid arteries EMT, and ultrasound indices of visceral and subcutaneous fat were measured in patients. In our study group, 53% of patients represented a very high cardiovascular risk, overweight or obesity was found in 68%, high body fat in 45%, and MS in 59% of individuals. Mean EMT (662 ± 129 µm) was significantly associated with EF area (r = 0.46; p < 0.001) and PF area (r = 0.3; p < 0.001). Among all fat indices, only EMT (MS+ 736 ± 140 µm vs. MS-658 ± 97 µm; p = 0.002) and EF area (MS+ 870 ± 451 mm(2) vs. MS 668 ± 333 mm(2); p = 0.02) were significantly increased in patients with MS compared with individuals without MS. Multivariable regression analysis also showed that mean EMT is independently associated with number of cardiovascular risk factors (b = 0.005; p < 0.001). Moreover, very high cardiovascular risk subjects showed significantly increased EMT/BMI (p < 0.001) and EF area/BMI (p = 0.03) ratios. However, there was no significant association between EMT/BMI and EF area/BMI values (p = ns). CONCLUSIONS: Our study showed the first findings on the relations between a novel ultrasound index EMT and EF assessed in a reference method of CMR. Carotid EMT may be a new surrogate marker, including both periarterial fat as a major component and arterial adventitia, which may provide additional data on cardiometabolic risk beyond that derived form a well-established EF alone.

IGF-1 response to arm exercise with eccentric and concentric muscle contractions in resistance-trained athletes with left ventricular hypertrophy.

The study aimed at evaluating changes in plasma levels of insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), testosterone, growth hormone (GH), cortisol, and insulin in resistance-trained male athletes with (n=9) and without (n=9) left ventricular hypertrophy (LVH) in response to eccentric (ECC) and concentric (CON) arm exercise. 10 age-matched healthy non-trained subjects served as controls. M-mode and 2D Doppler echocardiography were used to estimate LV mass.Resting IGF-1 concentration was higher in LVH athletes compared to controls (52 ± 5 nM vs. 46 ± 7 nM, p<0.05). ECC exercise resulted in higher (p<0.05) serum IGF-1 concentrations in athletes with LVH (70 ± 11 nM, n=9) compared to those without LVH (62 ± 10 nM, n=9), and to untrained controls (54 ± 6 nM). Both CON and ECC exercise resulted in higher serum IGFBP-3 levels in LVH athletes compared to controls (242 ± 57 and 274 ± 58, athletes, vs. 215 ± 63 and 244 ± 67, controls, nM, p<0.05). In ECC exercise, GH concentrations were lower in LVH than in non-LVH athletes (4.7 ± 2.1 vs. 6.1 ± 1.8 ng mL(-1), p<0.05). No differences in other hormones were found between groups. In conclusion, LVH is accompanied by elevated resting serum IGF-1 and enhanced response to eccentric arm exercise. These findings suggest a role of IGF-1, possibly released from contracting muscle, in stimulating LV hypertrophy in resistance training.

Expression of genes encoding kinin receptors in peripheral blood mononuclear cells from patients with acute coronary syndromes.

BACKGROUND: Inflammation plays a critical role in all stages of atherogenesis, including plaque destabilization leading to the rupture and local thrombosis, clinically manifested as unstable angina (UA) or myocardial infarction (MI). Recent data report enhanced expression of numerous pro-inflammatory genes in patients with acute coronary syndrome (ACS) both in plaque and in inflammatory cells. Kinins are peptides involved in vasodilation, vascular permeability, pain and inflammation. Their effects are mediated by two receptors, B1 and B2. As the role of kinins in ACS is not clear, the aim of the study was to assess the expression of the genes encoding kinin receptors in patients with ACS. METHODS: The study was carried out on 40 patients with ACS and 10 age-matched healthy subjects (control (C)). To evaluate gene expression of B1 and B2 kinin receptors, total mRNA was extracted from peripheral blood mononuclear cells and the number of mRNA copies was assessed by quantitative reverse transcriptase-polymerase chain reaction. RESULTS: In patients with MI and UA, the B1 receptor (B1R)/B2 receptor (B2R) ratio was inversed compared with healthy subjects (C group) (MI vs C: 1.54 +/- 0.39 vs 0.36 +/- 0.04; P < 0.01; UA vs C: 2.13 +/- 0.98 vs 0.36 +/- 0.04; P < 0.05 respectively). B2R gene mRNA level was markedly lower in MI group versus C group (24 216 +/- 5409 copies/microg vs 39 908 +/- 5309 copies/microg; P < 0.05). The difference in B1R gene expression between MI and C group was negligible. We have not observed differences in studied genes expression between UA and C groups. CONCLUSION: Patients with ACS show inverted B1R/B2R ratio. Such disturbance in kinin signalling may reflect increased activation of circulating mononuclears, which are important participants of atherosclerotic plaque development and eventually rupture.

Percutaneous coronary intervention with stent implantation in haemophilic A patient with unstable angina.

The prevalence of coronary artery disease (CAD) and acute coronary syndromes in patients with haemophilia is much lower than in general population and there is a lack of information regarding safe interventional or surgical treatment of CAD in haemophiliacs. This report presents a case of patient with moderate haemophilia A and unstable angina pectoris, who underwent successful coronary angioplasty. The patient was pretreated with factor VIII (before and after the procedure) and the incision site was sealed with vessel closure device. Additionally, the article discusses the issue of the safety of standard, postpercutaneous coronary intervention antiplatelet therapy in patients with haemophilia.

[Side effects during dobutamine stress echocardiography in patients with aortic stenosis]. / Bezpieczenstwo echokardiograficznego testu obciazeniowego z dobutamina zastosowanego u chorych ze zwezeniem zastawki aortalnej.

The purpose of the study was to assess the safety of the dobutamine stress echocardiography (DASE) in patients with aortic stenosis (AS). 161 patients (mean age 59 +/- 13 years) with AS were prospectively studied with DASE. There were 58 female and 103 male. Dobutamine was given in stepwise increasing doses from 5 to 40 ug/kg/min. Mean maximal dose achieved was 31.4 ug/kg/min. The test was positive in 40 (24.8%) patients. Significant coronary artery disease was present in 60 (37.3%) patients. DASE resulted in significant increase in transvalvular mean gradient from 29.3 +/- 12.5 mmHg at rest to 46.3 +/- 19.3 mmHg at peak dose. There was no significant increase in valve area. There were no death, myocardial infarction or episodes of sustained ventricular tachycardia as a result of DASE. The test was terminated when following conditions were revealed: target heart rate (39.1%), left ventricular asynergy (25.5%), maximal established dose achieved (8.1%), side effects (27.3%). The most common side effects with the need of test cessation were arrhythmias (9.9%) and hypotension (9.9%). The most side effects were usually well tolerated without need of medical treatment. We conclude that DASE may be safely performed in patients with AS. Side effects are more common than in patients with coronary disease, but are usually well tolerated without need of medical treatment.

[Is application of electrocardiographic exercise test always usefull in the diagnosis of coronary artery disease? Advantages and limitations of this method]. / Czy zawsze warto wykonywac elektrokardiograficzna próbe wysilkowa w rozpoznawaniu choroby wiencowej? Zalety i organiczenia metody.

UNLABELLED: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. Clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery. RESULTS: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%. CONCLUSION: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

[ECHO image quality of the left ventricle during dobutamine stress echocardiography]. / Jakosc obrazu echokardiograficznego w czasie testu obciazeniowego z dobutamina.

This study aimed at assessing ECHO image quality of the left ventricle during dobutamine stress echocardiography (ED). The study involved 582 patients without previous myocardial infarction. Their age ranged from 27 to 74 years, mean age 52 +/- 9. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg per minute. Atropine was added in 253 (43%) cases. The wall motion asynergy was evaluated by left ventricular echo image divided into 16 segments. At least one segment has not been visualised in 5.5% of patients. At the peak dose of administrated dobutamine (> 20 mcg/kg per minute) it increased to 6.1%. Unvisualized segments did not impair the test and did not affect negative or non diagnostic results, as was verified statistically. Patients' age, body weight and BMI did not exert a significant effect on the quality of echo image. Segments 5 and 11 were seen constantly during the whole test. Segment 13 was poorly visualised during the tests. Only in 1.5% of patients peak dose of dobutamine deteriorated the image, especially in segments 1, 3, 6, and 12. During the dobutamine echocardiography test the quality of ECHO image of left ventricular wall was worsening only in a few patients. It was not considered the reason of test interruption and did not impared the results of ED.

Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus cristalloid cardioplegia.

BACKGROUND: In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia. METHODS: To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively. RESULTS: The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb. CONCLUSIONS: The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.

[Side effects during dobutamine stress echocardiography: analysis of 582 studies]. / Objawy niepozadane echokardiograficznej próby dobutaminowej--analiza 582 badan.

The purpose of the study was to assess the safety, adverse effects and complications of the dobutamine stress echocardiography (ED). 582 patients without previous infarction were prospectively studied with ED. There were 196 female and 368 male, age varied from 27 to 74 years, mean 52. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg/min. Mean maximal dose achieved was 33 mcg/kg/min. Atropine was added in 253 (43%) cases. Significant coronary artery disease was present in 323 patients (53%). There were no death, no myocardial infarction or episodes of sustained ventricular tachycardia as a result of ED. The test was terminated when following conditions were revealed: target heart rate (28.9%), maximal established dose achieved (25.3%), left ventricular asynergy (19.6%), angina pectoris (10.8%), increase of systolic blood pressure above 220 mm Hg (2.6%), hypotension (7.6%), nonsustained ventricular tachycardia (1.7%). The most common non-cardiac side effects were skin tingling (19.8%), atypical chest pain(16.3%), palpitations (13.9%) and headache (7.9%). The most side effects were usually well tolerated, without the need for test cessation. The ED was terminated only in 4 (0.6%) patients because of non-cardiac side effects including nausea (0.3%) and headache (0.3%). We conclude that ED may be safely performed in routine clinical practice. Side effects were rare and usually minor. Most severe ischemic pain was relieved by test interruption and sublingual nitro-glycerine or short acting beta-blocker administration.

[The diagnostic value of resting electrocardiography in stable coronary artery disease]. / Wartosc diagnostyczna spoczynkowego badania elektrokardiograficznego w rozpoznawaniu stabilnej choroby wiencowej.

The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.

[Surgical revascularization of the myocardium in patients with chronic coronary disease and depressed left ventricular function: 1-year observation]. / Chirurgiczna rewaskularyzacja miesnia sercowego u chorych z przewlekla choroba niedokrwienna serca i uposledzona czynnoscia lewej komory: 1-roczna obserwacja.

Many reports confirm the importance and benefit of the surgical revascularization (CABG) in patients with ischemic heart disease and severely depressed left ventricular (LV) systolic function. This mode of treatment is better than medical therapy in patients with very low LV ejection fraction (LVEF) and can prolong the life. However, the effect of CABG on LV hemodynamics is still unclear. The aim of the study was: 1) to assess the effect of CABG on LV hemodynamics in patients with low LVEF and 2) to examine the influence of two types of cardioplegia-crystalloid (CC) and blood (BC) cardioplegia--on LV function during 1 year follow-up. 122 patients with stable angina pectoris qualified for CABG were included in the study. Patients were divided into two groups: group I-47 pts with LVEF < or = 40% and group II--75 pts with LVEF > 40% and then patients were randomized for two types of antegrade-retrograde cardioplegia (CC--subgroups Ia, IIa and BC--subgroups Ib, IIb). Before operation and 4 times after CABG (after 2-6 weeks, 3 months, 6 months and 1 year) echocardiographic examination was performed. Diameters of left atrium and ventricle, LVEF and wall motion score index (WMSI) were calculated. During 1 year 8 patients died (5 of them during perioperative period and 3 patients during follow-up). Patients in group I before operation were in higher NYHA and CCS class and had more often myocardial infarction. During each of the five echocardiographic examination the values of LVEF and WMSI did not differ between subgroups Ia vs Ib and IIa vs IIb. In group I, especially in patients with very low LVEF < or = 30%, the values of LVEF and WMSI improved significantly (p < 0.001) during 1 year of follow-up. But in group II a transient deterioration of LVEF (p < 0.05) 2-6 weeks after CABG was noted. We conclude that surgical revascularization in patients with severe depressed hemodynamics improves LV systolic function during 1 year follow-up. The use of CC or BC did not seem to make any difference to the early and long-term hemodynamic effect of the revascularization.

Circulatory system in children with localized scleroderma.

The circulatory system was studied in 43 children (ages 3-18 years, mean 10.6 years; 32 girls, 11 boys) suffering from localized cutaneous forms of scleroderma. The following studies were undertaken: general pediatric examination, cardiologic examination including routine electrocardiogram (ECG), 24-h Holter ECG monitoring, echocardiography plus Doppler study, and a treadmill exercise test. Three children found to have congenital heart malformations were excluded from the study. Children with localized scleroderma were often lighter and shorter than their appropriate controls. The most common ECG abnormality was incomplete right bundle branch block, but other ECG and Holter abnormalities were found as well. Abnormal echocardiographic results were obtained in 16 cases. The abnormalities concerned valvar function (in all heart valves but predominantly in the mitral valve). It was found that the children suffering from scleroderma had different indices than controls for left ventricular mass index, mitral valve function and left ventricular filling. During the exercise test (conducted according to Bruce's protocol) we found no difference between patients and controls.

[Evaluation of antiarrhythmic efficacy of sotalol in various doses in patients with ventricular tachyarrhythmias]. / Ocena skutecznosci przeciwarytmicznej sotalolu w róznych dawkach u chorych z komorowymi zaburzeniami rytmu.

UNLABELLED: Antiarrhythmic efficacy of sotalol--noncardioselective beta-adrenergic blocking agent with class III antiarrhythmic action was evaluated in 34 patients [pts] (mean age 55 +/- 11) with chronic ventricular arrhythmias and coronary artery disease, 38% with previous myocardial infarction. Two schedules of dosing were tested: 3 x 80 mg and 2 x 160 mg during 28 days of therapy. Pts with Lown class II and IV arrhythmia derived from 24-hours Holter recording were assigned. Ventricular premature complexes [VPCs] and couplets reduction by 80% and total elimination of runs defined antiarrhythmic efficacy. Proarrhythmia was defined by four times increase in VPCs, ten times increase in couplets and runs or sustained VT episodes. RESULTS: Antiarrhythmic efficacy of two doses of sotalol according to study criterion was: 31% for lower dose (3 x 80 mg) and 24% for higher dose (2 x 160 mg). Overall efficacy for both doses was 55%. According to Morganroth criterion, lower dose was effective in 29% pts and both doses, lower and higher, in 41% pts. According to other commonly used criterion: 70% VPCs reduction, 90% couplets reduction and total elimination of runs, lower dose of sotalol was effective in 32% pts and both doses in 47% pts. Significant reduction of heart rate and prolongation of QT and QTc were observed. In 3 pts QT was prolonged over 500 ms. Proarrhythmia according to Velebit criterion was suspected in one patient after one week of 3 x 80 mg teratment which caused premature cessation of therapy. No significant abnormalities in laboratory values were observed. CONCLUSIONS: Antiarrhythmic efficacy of sotalol was comparable to other studies. Its value in pts with malignant ventricular tachyarrhythmias: sustained ventricular tachycardia and ventricular fibrillation requires further studies with higher number of patients.

[Echocardiography examinations in children suffering from cutaneous forms of scleroderma]. / Badanie echokardiograficzne dzieci obarczonych skórnymi postaciami twardziny.

In 34 children suffering from so called cutaneous forms of scleroderma and in 30 healthy subjects echocardiographic cardiac assessment as well as doppler analysis of mitral valve function was performed. It was found that sclerodermic children suffered more frequently from cardiac valves regurgitation (especially insufficiency of mitral valve). However, these insufficiencies were usually negligible or corresponding to Io. Other changes detected in these children were as follows: significantly higher values of left ventricle shortening fraction, increased left ventricle mass index, and changes of mitral flow which may reflect impaired diasystolic function of left ventricle and, perhaps, impaired left atrium contraction. It is suggested that such changes could be corresponding to the beginning of cardiomyopathy.

[The circulatory system in children with cutaneous forms of scleroderma. The results of routine as well as 24-hour ECG and physical performance test]. / Uklad krazenia dzieci obarczonych skórnymi postaciami twardziny. Wyniki rutynowego i 24-godzinnego ekg oraz próby wysilkowej.

Thirty-four children suffering from so-called cutaneous forms of scleroderma were studied (physical examination, routine and 24-hour ECG, and physical performance test). Physical development was significantly impaired in 5 cases. Congenital heart malformations with left-to-right shunt were detected in 3 children. These children underwent surgery with good results. Heart murmur was found during physical examination in 14 cases. In 30 subjects routine ECG was described as abnormal or doubtful. Abnormal Holter monitoring results were found in 13 children. The authors were not able to detect inferior physical performance test results in the studied children as compared to the control group (when the children suffering from congenital heart malformations and resting tachycardia were excluded from the study). It is suggested that children suffering from so-called cutaneous forms of scleroderma should remain under constant cardiological care.

[Left ventricular systolic function after PTCA--recent and late assessment by exercise echocardiography]. / Funkcja skurczowa lewej komory po plastyce tetnicy wiencowej--wczesna i odlegla ocena metoda echokardiografii wysilkowej.

The purpose of this study was to determine whether global and segmental left ventricle (LV) systolic function, assessed by exercise echocardiography (EE), improves after PTCA in patients without previous myocardial infarction (MI) and after infarction and angioplasty of infarct related coronary artery. 32 patients without MI and 35 patients with previous (4 +/- 3 months) MI were examined before PTCA (percutaneous transluminal coronary angioplasty), 3-5 days after successful elective PTCA and 6 months later with EE (modified Bruce protocol). LV ejection fraction (EF) and wall motion score index (WMSI) at the baseline and immediately after exercise were assessed. Following angioplasty (after 3-5 days and 6 months later), exercise duration was significantly (p < 0.001) increased in both groups of patients. Resting EF and WMSI did not change after angioplasty of infarct-related artery, but in patients without prior MI resting EF increased (p < 0.001) after PTCA in comparison with pre-PTCA values. Significant improvement of exercise EF and WMSI were observed in both groups of patients. In 25 of 35 patients with old MI wall motion improvement in the infarcted region after PTCA was observed. Twenty of these 25 patients developed exercise-induced akinesia in this area during pre-PTCA EE. Among 10 patients without improvement of the regional contractility were 9 after type Q-wave infarction and only 2 developed angina during EE. These data demonstrate improvement in global and regional systolic LV function and better exercise tolerance following successful PTCA both in patients without prior MI and with old MI after angioplasty of a stenosis in an infarct-related coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of physical exercise on the function of prosthetic heart valves--evaluation by doppler echocardiography]. / Wplyw wysilku fizycznego na funkcje sztucznych zastawek serca--ocena metoda echokardiografii Dopplerowskiej.

Although considerable data exist regarding the function of prosthetic heart valves (PHV) at rest, few data exist regarding the response to exercise. Thus, we studied by Doppler echocardiography 81 asymptomatic patients with PHV (46 mitral, 45 aortic) of varying type and 20 normal persons before and after symptom limited upright bicycle exercise. Rest and exercise hemodynamics (blood velocity, gradients, heart rate, stroke volume and cardiac output) was examined. In patients with mitral PHV maximal (Gmax) and mean (Gmean) gradients increased from 9.9 to 17.8 mmHg and from 4.4 to 7.8 mmHg (both p < 0.001), respectively. In patients with aortic PHV Gmax and Gmean increased from 27 to 42 mmHg and from 16 to 24 mmHg (both p < 0.001), respectively. Linear regression analysis demonstrated a relationship between the % change in gradient with exercise nd % change in stroke volume and cardiac output. Importantly, the largest gradient produced by exercise is related and predicted by the rest gradient. In comparison with normal valves, maximal and mean blood velocity were significantly (p < 0.001) greater across PHV, but % change in velocity with exercise did no differ significantly between prosthetic and normal valves. In conclusion, exercise Doppler echocardiography provides a good method to assess PHV function.

Long-term antiarrhythmic pharmaco-therapy guided by Holter monitoring in patients with malignant ventricular arrhythmias and ischemic heart disease.

In 126 patients with clinical ventricular tachycardia and/or fibrillation, ischemic heart disease and repetitive and/or frequent ventricular ectopic beats long-term therapy guided by Holter ecg was assessed. Criteria for efficacy of antiarrhythmic drugs were following: 1) > 75% decrease in ectopic beats, 2) elimination of salvos, 3) > 90% reduction of couples and R/T and 4) reduction of multiformity up to 2 forms. They were fulfilled in 71% of patients (responders). During follow-up 1-49 months, mean 20, rate of sudden death was lower in responders as compared with nonresponders (p < 0.05). However, suppression of ventricular ectopic beats was not predictive for a favorable outcome, because the incidence of arrhythmic events and total cardiac death was similar in the two groups.