Relation between postoperative mortality and atrial fibrillation before surgical revascularization--3-year follow-up.

BACKGROUND: Preoperative atrial fibrillation is one of the predictors of increased morbidity and mortality in patients undergoing surgical revascularization, and consequently, prolongs the duration of stay in the ICU and of overall hospitalization. METHODS: The study included 3000 patients subjected to primary isolated coronary artery bypass grafting from 2000 to 2004. Of the 3000 patients, 5.8 % (n = 174) had electrocardiographically documented, preoperative atrial fibrillation. To evaluate the relationship between preoperative AF and postoperative outcome, all patients were observed for about three years. RESULTS: Patients with preoperative atrial fibrillation were older (P < 0.05), had a lower ejection fraction (P < 0.001), a higher incidence of heart failure (P < 0.001), hypertension (P < 0.001), and more coexistent morbidities including diabetes (P < 0.05), obturative pulmonary disease (P < 0.0001) and mild renal failure (P < 0.001). Statistical analysis showed that survival rates at 6 and 30 days, 6 and 12 months, and 3 years following surgical revascularization of patients with vs. those without preoperative atrial fibrillation were: 96.4% vs. 98.1%, and 94.5% vs. 97.3% (P = ns), 86.2% vs. 93.0% (P < 0.03), and 74.7% vs. 91.0% (P < 0.02), and 70.7% vs. 90.6% (P < 0.01). After 3 years' observation there was a survival difference of 19.9%. We showed that preoperative atrial fibrillation triple increased the risk of postoperative AF and was an independent risk factor for in-hospital death (P < 0.001). CONCLUSIONS: Preoperative atrial fibrillation is a predictor of postoperative complications, including death, and of a significant reduction in patients' long-term survival. Patients with preoperative atrial fibrillation should be considered as high-risk patients with potential postoperative complications and should be well protected with antiarrhythmic and anticoagulant therapy.

Echocardiographic evaluation of the left atrium and left atrial appendage function in patients with atrial septum aneurysm: implications for thromboembolic complications.

BACKGROUND: Our study aimed to assess left atrium (LA) and left atrial appendage (LAA) function in patients with atrial septum aneurysm (ASA) and to relate it to thromboembolic complications. METHODS: The study group comprised 25 patients with isolated ASA (group I) and 17 clinically healthy subjects (control group = group II). Transthoracic and transesophageal echocardiography were performed in all investigated patients. RESULTS: In group I, the following parameters were significantly higher than in the controls: LA minimal dimension (LA (min)) was 2.13 vs. 1.7 cm; LA presystolic dimension (LA (a)) was 2.66 vs. 2.29 cm and LA pre-ejection period/LA ejection time index (PEP/ETLA) was 1.26 vs. 0.41 ( P < 0.05). There were no statistically significant differences between groups as to P wave and PR-interval duration, which were 69 vs. 72 ms and 167 vs. 173 ms, respectively. All LAA parameters were investigated, but LAA minimal areas (LAA (area min)) were higher in the study group than in controls: LAA transversal dimension (LAA (trans)) was 1.89 vs. 1.32 cm; LAA longitudinal dimension (LAA (long)) was 4.24 vs. 3.11 cm; LAA maximal area (LAA (area max)) was 4.35 vs. 3.1 cm (2); LAA ejection fraction (EFLAA) was 56 vs. 33 %; LAA peak emptying (LAAE) was 0.64 vs. 0.41 m/s, and filling velocities (LAAF) was 0.55 vs. 0.42 m/s ( P < 0.05). The results indicate a depression of LA systolic and an enhancement of LAA function in patients with ASA compared with clinically healthy subjects. CONCLUSION: (1) Atrial septum aneurysm impairs left atrium systolic function. (2) In patients with atrial septum aneurysm, left atrium appendage function changes; its systolic as well as a reservoir function improve. (3) The enhancement of LAA function in ASA may be a compensatory mechanism for LA systolic function deterioration. (4) As LAA systolic function is enhanced, it is rather unlikely that LAA is the place of origin of thrombi, which occur relatively frequently (according to the literature) in patients with ASA. The thrombi seem to be formed in the bulging sack of ASA, i.e., in the part of the LA whose systolic function is depressed.

Risk factors for atrial fibrillation in adult patients in long-term observation following surgical closure of atrial septal defect type II.

BACKGROUND: The aim of the study was to find the factors predictive for paroxysmal atrial fibrillation (AF) following surgical correction of atrial septal defect type II (ASD t.II). METHODS: 93 patients, who underwent isolated surgical closure of ASD t.II between 1990 and 2001 were included. Follow-up studies were performed 2 - 11 years after surgery. Patients were divided into two groups according to the presence of AF before and after surgery. Group AF (+) consisted of 29 and group AF (-) of 64 patients. All patients underwent echocardiography, electrocardiogram (ECG) at rest, and signal-averaged P-wave duration (PWD) in signal-averaged ECG. The following parameters were assessed in echocardiography: pulmonary artery systolic pressure, left and right atrial dimensions, right ventricular dimension, tricuspid and mitral regurgitation. RESULTS: Paroxysmal AF was observed in 27 patients before surgery and in 29 after surgery. Analyzing all potential risk factors we proved that PWD may independently predict occurrence of postoperative AF. CONCLUSION: PWD may independently predict postoperative AF in long-term follow-up after surgical correction of ASD t.II.

[Effects of nitrates and beta-blockers on platelet aggregation in patients with coronary heart disease]. / Wplyw azotanów i leków blokujacych receptory beta na agregacje krwinek plytkowych u chorych na chorobe wiencowa.

Our study aimed at evaluating an effect of the selected nitrates and beta adrenoceptor blockers on platelet aggregation in patients (pts) with coronary artery disease (CAD). The study included 168 male patients (M), aged between 33 and 72 years (mean age 51 +/- 7). 61 M given isosorbide dinitrate were divided into three groups: in the group I and II an effect of the drug on the platelet aggregation following a single 10 mg (I) and 20 mg (II) dose has been evaluated; in group III an effect of the drug after a two-week treatment has been evaluated. 14 male patients (group IV) were given 5-mononitrate 40 mg daily for two weeks. 85 male patients, treated with propranolol have also been divided into three groups. In group V and group VII an effect of propranolol on platelet aggregation following a single dose of 40 mg and 80 mg has been evaluated respectively. In the group VII an outcome of a two-week propranolol therapy has been assessed. Eleven patients (group VIII) received nadolol in a dose of 40-80 mg daily for two weeks. Platelet aggregation induced by adenosine diphosphate (ADP) in concentration of 1 mM/ml and 5 mM/ml (groups I, II, III, V, VI, VII) and only of 1 microM/ml (groups IV, VIII) was evaluated with Born's method. In patients with CAD only isosorbide dinitrate inhibits platelet aggregation. This effect has been noted following a single dose as well as a two-week treatment. Other drugs (5-mononitrate, propranolol, nadolol) transiently increase platelet aggregation, but became either ineffective after two-week therapy (5-mononitrate, nadolol) or increase (propranolol) platelet aggregation. Tendency to inhibit (sorbonit) or to increase (propranolol) platelet aggregation has been more pronounced with higher concentration of aggregating factor.

Non-invasive methods of atrial function evaluation in heart diseases.

The article describes four essential components (hemodynamic, bioelectrical, hormonal, metabolic) of atrial function. The role atria play in heart hemodynamic performance by virtue of their reservoir, conduit and active contractile function is emphasized. Next, the authors relate various non-invasive diagnostic methods in cardiology to the estimation of particular types of atrial function in physiological and in selected pathological conditions. Only non-invasive and easy accessible in clinical practice diagnostic methods are presented. The use of echocardiography for the evaluation of hemodynamic function of atria and left atrial appendage is particularly exposed.

[The influence of thrombolytic therapy on selected parameters of left ventricular function in acute myocardial infarction]. / Wplyw leczenia trombolitycznego na wybrane wskazniki funkcji rozkurczowej lewej komory serca w okresie swiezego zawalu miesnia sercowego.

Our study aimed to evaluate the influence of thrombolytic therapy on some left ventricle (LV) function parameters in patients with acute myocardial infarction. The study was performed on 44 pts admitted to hospital due to acute myocardial infarction. The patients were divided into two groups: I group--30 pts (26 male, 4 female) at average age 57 +/- 10 who were treated with tissue plasminogen activator (t-PA) routinely and II group--14 pts (9 male, 5 female) at average age 62 +/- 10 in whom thrombolytic therapy was contraindicated for various reasons. Transthoracic echocardiography was performed just before treatment (0), 3.5 hours after the onset of drug administration (2 hours after the end of t-PA injection) (1) and on the 10th day of hospitalization (2). Control group consisted of 16 clinically healthy individuals (12 male, 4 female) at average age 54 +/- 9. The following parameters were evaluated: DT-E--wave of early diastolic transmitral flow deceleration time, IVRT--isovolumic relaxation time, E/A--early/atrial peak flow velocity ratio of transmitral flow, LATEF%--left atrial total emptying fraction, EF--left ventricle ejection fraction. In patients with acute myocardial infarction shortening of DT, prolongation of IVRT, lower E/A ratio and decrease of LATEF% compared to controls were observed. In group I EF was less than in clinically healthy individuals. E/A ratio was higher in pts from group I than from group II. In patients treated with t-PA 2 hours after treatment as well as on the 10th day significant prolongation of DT, shortening of IVRT and increase of LATEF% were observed. These changes were accompanied by the increase of EF. In patients with acute myocardial infarction not treated with t-PA significant increase in E/A ratio and EF on 10th day were observed. On the basis of the results were conclude: In patients with acute myocardial infarction LV diastolic function and with unproper relaxation as well as unproper compliance of LV myocardium is present. In patients with thrombolytic therapy LV filling pattern improves just two hours after t-PA administration (DT prolongation, IVRT shortening, LATEF% increase). Such tendency remains on the 10th day after treatment. In patients without thrombolytic therapy slight improvement occurs no sooner than on the 10th day of the MI.

[The significance of scintigraphic, echocardiographic and electrocardiographic left atrial transesophageal pacing in diagnosis of ischemic heart disease]. / Znaczenie scyntygraficznego, echokardiograficznego i elektrokardiograficznego testu stymulacji przezprzelykowej lewego przedsionka w diagnostyce choroby niedokrwiennej serca.

UNLABELLED: The aim of the study was to compare the perfusion scintigraphy (using SPECT method with Tc-99-MIBI) during left atrial transoesophageal pacing test (LAPT) with pacing electrocardiography (ECG), echocardiography (ECHO) and electrocardiography exercise test (ExT) in ischaemic heart disease (IHD) diagnostics. The effect of LATP on heart haemodynamic parameters and the correlation between scintigraphic, echocardiographic and electrocardiographic parameters during LAPT test have been also assessed. Investigations were carried out in 55 subjects (Group I: 36 patients with effort angina pectoris; group II: controls: 19 clinically healthy subjects). Coronarography was performed in 24 patients 6 weeks before or after examinations. LATP test was analyzed with ECG, ECHO and SPECT. Echocardiography did not increase significantly the LATP test diagnostic value. Perfusion scintigraphy enhanced sensitivity and predictive excluding value LATP test. These values were 93.3% v 62.9% and 90% v 59.3% respectively. LATP test assessed with ECG, ECHO and perfusion scintigraphy expressed significantly higher sensitivity and predicting excluding value in comparison to ExT. LATP test analyzed in such way was characterized by 100% sensitivity and 100% predicting excluding value. CONCLUSION: Combination of LATP with electrocardiography, echocardiography and SPECT is a non-invasive high quality method for ischaemic heart disease diagnostics.

Evaluation of myocardial muscle functional parameters in patients with multiple sclerosis.

Structural and functional parameters of myocardium were evaluated with 2D+ Doppler echocardiography in two similar age groups of MS patients: S1: 12 subjects in 3-4 Degrees EDSS (Expanded Disability Status Scale), S2: 12 subjects in 5-7 degrees EDSS. The control group comprised 12 healthy subjects temporarily (at least 1 month) immobilized due to lower limb fractures. Investigations were performed in the supine position and 3 min after tilting to the erect position. Symptoms of organic myocardial injury which might have caused its insufficiency were not observed in any subjects. All structural parameters evaluated by this method did not differ significantly in the examined groups. Symptoms suggesting myocardial insufficiency were found in patients from group S2. Statistically significant decrease of ejection fraction (EF) and cardiac output (CO) was observed in the supine position of S2 patients as compared to S1 and the controls. These symptoms intensified in the erect position in S2 patients and they were accompanied by the decreased values of stroke volume (SV). The fact that in the majority of patients orthostatic hypotonia was not observed and that those disorders were not compensated by significant intensification of heart rate suggest to us that besides disorders resulting from autonomic nervous system dysfunction they may have been caused by secondary myocardial injury in the course of MS.

[Function of the left heart atrium during hemodialysis]. / Czynnosc lewego przesionka serca podczas hemodializy.

In 23 chronic uremic patients effect of four-hour hemodialysis on function the left atrium of the heart was investigated. The reference group consisted of 17 healthy subjects. The function was evaluated by cross-sectional Doppler echocardiography. Before hemodialysis maximal (LAmax) and minimal (LAmin) left atrial dimensions and left atrial dimension obtained in M-mode of long axis in parasternal projection (LAa), pre-ejection period (PEPlp), ejection time (ETlp), PEPlo/ETlp ratio and left atrial fiber shortening fraction (FS%lp) were significantly higher in chronic uremic patients than those found in healthy subjects. Four-hour hemodialysis induced decreases in these indices, but only a lowering of LAa, PEPlp/ETlp ratio was statistically significant in comparison with pre-dialysis period. No correlation was found between changes of the investigated indices of the left atrial function and body weight loss during hemodialysis.

[Role of selenium in human pathophysiology]. / Rola selenu w patofizjologii czlowieka.

Paper describes selenium metabolism and its function in physiological and pathological states. A role of selenium in development of human internal pathology with its action in suppressing the carcinogenesis is outlined. Function of selenium in biochemical structures is showed with a special stress put on glutathione peroxidase.

[A free radical mechanism for inhibition of arteriosclerosis development with calcium antagonists]. / Wolnorodnikowe mechanizmy hamowania rozwoju miazdzycy przez antagonistów wapnia (ACa).

Work presents current views on involvement of free radicals in inhibition of development of arteriosclerosis by calcium antagonist (ACa). The importance of other substances, which interferes with calcium ions can contribute to the inhibition of arteriosclerosis development.

[Free radicals and their importance in medicine]. / Wolne rodniki i ich znaczenie w medycynie.

The work presents current views of free radicals and their role in medicine. In the first fact, the chemical nature of free radicals, their reactions in cells and its consequences are discussed. The second part deals with a role of free radicals in human pathology with a special stress put an arteriosclerotic process. In the third part, the defense mechanism against free radical action, particularly the importance of superoxide dismutase.

[The value of 2-dimensional echocardiography in conjunction with various exercise tests for diagnosis of myocardial ischemia]. / Zur Bedeutung der zweidimensionalen Echokardiographie in Verbindung mit verschiedenen Belastungstests für die Diagnostik der myokardialen Ischämie.

In 16 persons of the control group (group I) and in 27 patients with coronary heart disease (group II) value of two-dimensional echocardiography was determined combined with exercise, transoesophageal left atrial pacing, dipyridamole and cold pressor tests in detecting myocardial ischaemia. Changes of ST-segment in the ECG, left ventricular ejection fraction and wall motion in the 11 segments were studied during the tests. Sensitivity, specificity and predictive value confirming and excluding ischaemic heart disease of the analyzed parameters were determined. The sensitivity and the specificity of exercise, left atrial pacing, dipyridamole and cold pressor tests during the analysis of ST-segment were 70%, 81%, 37%, 4% and 62%, 67%, 94%, 100%, respectively. Two-dimensional echocardiography analysis did not increase the diagnostic value of the exercise and left atrial pacing tests, whereas the diagnostic value of dipyridamole and cold pressor tests were increased.

[Platelet aggregation in patients with coronary disease treated with nifedipine]. / Agregacja krwinek plytkowych u osób z choroba wiencowa leczonych nifedypina.

The effect of nifedipine on the aggregation of blood platelets has been studied in patients with coronary heart disease. The study involved 78 males, aged between 36 and 64 years (mean age 51 years). The level of aggregation was evaluated before and after a single nifedipine dose of 10 mg (in 15 patients) and of 20 mg (in 34 patients) as well as before and after the treatment with nifedipine (of 29 patient) with a daily dose of 30 mg for two weeks. Aggregation of blood platelets induced by adenosine--diphosphate in of concentrations 1 microM/ml and of 5 microM/ml were estimated by the Born method. It was found that nifedipine reduces the aggregation of the blood platelets in patients with coronary heart disease following single and long-term treatment.