QT response after a test dose and during maintenance therapy with AZD1305 in patients with atrial fibrillation: a double-blind, randomized, placebo-controlled trial.

BACKGROUND AND OBJECTIVE: AZD1305 is an investigational antiarrhythmic agent that prolongs refractoriness through combined potassium and sodium channel inhibition. This study aimed to explore the utility of a test dose in predicting QT interval corrected according to Fridericia's formula (QTcF) during subsequent maintenance treatment with AZD1305. METHODS: This was a randomized, double-blind, parallel-group, placebo-controlled trial carried out at multiple hospital cardiac facilities in Denmark, Norway, Poland, Slovakia, and Sweden. Patients with documented atrial fibrillation (AF) but currently in stable sinus rhythm for ≥2 hours and ≤90 days were eligible for inclusion. Patients were randomized in a 1 : 1 : 1 ratio to receive AZD1305 extended-release or matching placebo tablets as follows: group A - test dose 250 mg, evening dose 125 mg on day 1, maintenance dose 125 mg twice daily; group B - test dose 500 mg, placebo evening dose, maintenance dose 125 mg twice daily; placebo group - placebo test and maintenance dose. Maintenance dosing was for 9 days. QTcF >550 ms at any time during the in-patient phase or >500 ms after discharge (day 4) were predefined study drug discontinuation criteria. The main outcome measure was the relationship between QTcF following the test dose and during maintenance treatment. RESULTS: Sixty-five patients were randomized (n = 21, 22, and 22 in group A, group B, and the placebo group, respectively). AZD1305 dose-dependently increased QTcF. There was a positive, linear correlation between the change in QTcF during the first 6 hours after the test dose and during the maintenance phase. Three patients, all from group B, discontinued treatment on day 1 due to QTcF >550 ms. All other patients completed the study without events related to QT prolongation. There was a trend for reduced AF recurrence with AZD1305 compared with placebo. CONCLUSION: In this exploratory study a test dose predicted the QT response during maintenance treatment with AZD1305 and may thus be employed in further studies. [ClinicalTrials.gov Identifier: NCT00643448].

[The Bland-White-Garland syndrome detected during qualification for surgery, due to significant mitral regurgitation]. / Zespól Blanda-White'a-Garlanda ujawniony w trakcie badan diagnostycznych u chorego kwalifikowanego do operacji z powodu duzej niedomykalnosci mitralnej.

A case of a 57-year-old patient admitted to the hospital due to aggravation of heart failure symptoms is presented. In ECHO examination severe mitral insufficiency was found. During coronary angiography ostium of left coronary artery from pulmonary trunk was found. The patient underwent cardiosurgery: artificial mitral valve implantation, bypass LIMA-LAD grafting and natural opening left coronary artery ligation.

[Prognostic useful of the new risk index for infective endocarditis]. / Rokownicze znaczenie nowego wskaznika ryzyka u chorych na infekcyjne zapalenie wsierdzia.

UNLABELLED: The aim of study was the separation of the group of patients with the high risk of death based on the risk index (I(R)) calculated with use of C-reactive protein and hemoglobin concentrations measured on the admission. MATERIAL AND METHODS: The initial group consisted 41 patients (16 women and 25 men) hospitalized between 1999 and 2005 with the recognition of the infective endocarditis based on the Duke University criteria. The IR was calculated according to the formula: I(R) = [(CRP[mg/l])/(Hgb[g/dl]-beta)] x 10, and the coefficient beta = 6 g/dl. RESULTS: The I(R) was significantly higher among deceased patients than among patients with good early prognosis (376,6 vs 79,9; p < 0,001). The risk index exceeding 100 is strongly associated with high death risk among patients with infective endocarditis. CONCLUSION: This index may also be very useful in reaching the diagnosis and the efficacy prognosing of treatment.

[Short QT syndrome--a case report]. / Zespól skróconego odstepu QT--opis przypadku.

We present two new cases of the short QT syndrome--a 23-year-old male and his 42-year-old mother. Invasive electrophysiological study was negative in both patients. Due to polymorphic ventricular tachycardia recorded during Holter ECG monitoring, an ICD was implanted in the male patient for primary prevention. Blood samples were collected for further genetic studies. Diagnosis and management of patients with the short QT syndrome are discussed.

[The some risk factors for atherosclerosis in men with coronary artery disease depending on the age]. / Niektóre wskazniki zagroienia rozwojem choroby wiencowej u meiczyzn w zaleznosci od wieku.

UNLABELLED: The aim of this study was to search to the factors favouring the earlier revealing of a coronary artery disease by comparing selected immunological, hormonal and biochemical parameters between two groups--younger and older men with coronary artery disease and with responding control groups. MATERIAL AND METHODS: In the study were included 93 men--60 with stable angina, confirmed by coronarography (at least 6 months after CABG, PTCA or myocardial infraction, with EF > 40%) and 33 men without atherosclerotic changes in the coronary vessels, as the control group. The two groups were divided depending on age: the younger subgroups [under 60-ty years old--group A with CAD (n=30) and B without CAD (n=18)] and the older subgroup [over 70-ty years old group C with CAD (n=30) and D without CAD (n=15)]. RESULTS: Significantly lower concentration were noted for TNF-alpha--in control groups--by about 50% in the younger and 23% in the older group (r = 0.49) and homocysteine (by about 20% and 22% respectively, r = 0.40). Patients with CAD had higher concentration of CRP then in the control groups (by 52% and 54%, r = 0.28). Weak but positive correlation with the presence of a coronary heart disease was show for IgE and anti-gliadin antibodies (r = 0. 22-0.29). CONCLUSION: The younger and older men with CAD statistically significantly differed in concentration of TNF-alpha and homocysteine.

Work ability in ageing workers suffering from chronic diseases.

The aim of this study was to investigate the work ability in ageing workers suffering from osteoarthritis (OA), coronary heart disease (CHD) or hypertension (H). One hundred and sixty-six OA and 355 CHD/H outpatients were evaluated. The Work Ability Index (WAI) served for work ability assessment. Patients' results were compared with the results of a control group of 225 healthy young workers. Statistical analysis was performed with ANOVA tests. WAI in female and male CHD/H patients was higher than in OA patients (p < .01), better work ability was related to better education (p < .01), white-collar work (p < .01) and better recreation (p < .01); subjective work ability was determined mostly by the objective health status. The promotion of work ability among workers suffering from advanced age-related diseases should be closely related to the promotion of health. It is indicative to improve occupational education and skills, already at an early stage of a disease.

[Lipid and carbohydrate disturbances in men with coronary artery disease according to age]. / Zaburzenia gospodarki lipidowej i weglowodanowej u mgiczyzn z choroba wiencowa w zaleznosci od wieku.

The aim of this study was to search for the factors favouring the revealing of a coronary artery disease by comparing selected lipids and carbohydrate parameters between two groups--younger and older men with coronary artery disease. Into the study were included 60 men with stable angina confirmed by coronarography (at least 6 months after CABG, PTC A or myocardial infraction, with EF > 40%) and 33 men without atherosclerotic changes in the coronary vasseles as the control group. The two groups were divided depending on age: the younger subgroup [(under 60-ty years old-group: A with CAD, n = 30) and (B without CAD, n = l8)] and older subgroup [(over 70 years old-group: C with CAD, n = 30) and (D without CAD, n = 15)]. Men of middle age were not included. Serum semples were analyzed for the concentration of lipids parameters including apolipoprotein AI and B. The oral glucose tolerance test was carried out for all patients. In control groups (B and C) in comparison to the groups with CAD (A and C) was observed significantly higher concentration of the HDL cholesterol (by abouth 28% in younger men and 16% in older men (r with CAD = 0.40) and ApoAI (respectively by about 17% and 12.5%, r = 0.47). Weak, but positive corelation with the presence of coronary heart disease was shown for fasting glucose concentration. The younger and older men with CAD (A vs C) statistically significantly differed in concentration of HDL (a.v. 9.1 +/- 6.2 vs 46.7 +/- 11,7 ng/dl) and strongly correlated with HDL ApoAI (av. 137.6 +/- 12.6 vs 146.6 +/- 21.5 ng/dl). The negative family history was more often in younger patients.