Follow-up of hemorheological parameters and platelet aggregation in patients with acute coronary syndromes.

Pathologic hemorheological parameters and increased platelet aggregation in association with other risk factors significantly increase the possibility of the development of myocardial ischemia. Hemorheological parameters and platelet aggregation were investigated in 157 patients (mean age: 65+/-12 years) with acute coronary syndromes and in 68 healthy subjects (mean age: 36+/-6 years). Plasma fibrinogen, plasma and whole blood viscosity, red blood cell aggregation and filterability and platelet aggregation were measured in the hospital phase (after admission, on 2nd and 6th days) and monitored after discharge (at 1, 6 and 12 months). After admission all these parameters were significantly higher in patients than in control subjects (p<0.01) and almost all of them remained in the pathologic range at discharge. Some of the rheologic parameters showed a slight improvement after 1 month, but hematocrit and whole blood viscosity were higher than those after admission and of control subjects (p<0.05). After 6 and 12 months these parameters showed a small, but significant increase. Pathologically altered hemorheological parameters could be observed in patients with classical cardiovascular risk factors and significant improvement was found after elimination of them. Antiplatelet therapy was efficient in about half of the treated patients after admission; and despite a significant improvement, the proportion of ineffectively treated patients was still considerable during the follow-up. Our results support the role of abnormal hemorheological parameters in the development of myocardial ischemia and draw attention to the rheologic risk of these patients. The results of platelet aggregation measurements show the insufficiency of antiplatelet therapy at some cases and confirm the importance of guided secondary prevention.

Selected Physical Characteristics of Medical Students.

The purpose of this study was to measure selected anthropometrical characteristics, motor abilities and cardiorespiratory functions of medical students. Eighty-seven students were involved in this investigation. The students were categorized into five groups: (1) recrea-tional, doing sport activities irregularly, (2) basketball and (3) handball players, having training at least two times per week, as well as men (4) and women (5) students entering medical school. In all groups the mean body mass index and waist-to-hip ratio were at the upper level of the normal range, while body fat percentage was similar to standards for sedentary subjects. Better motor performances were obtained from the basketball and handball players than from the other groups. Static strength for the sample was somewhat above the normal sedentary level. The resting blood pressure and heart rate for most subjects were in the normal. Cardiovascular risk factors were found in six students. Their systolic blood pressure was above 140 mm Hg. There were no subjects identified with low blood pressure. The heart rate was elevated for three students from the recreational group, and in the women. Bradycardia did not occur. The vital capacity and the ability to hold one's breath was at the upper level of the normal range. The present results emphasis the need to improve the students prevention oriented life style through participation in exercising.

[Beneficial effect of the ACE inhibitor captopril in normotensive patients with insulin-dependent diabetes]. / Az ACE-gátló captopril kedvezö hatása normotenziós, inzulindependens cukorbetegekben.

The increase of glomerular filtration can often be observed in patients with insulin dependent diabetes mellitus, even in the early stage of the disease and it does not require the presence of microalbuminuria. This phenomenon can be explained by vasoconstriction occurring in the efferent arterioles. Eighteen normotensive, diabetic patients (aged: 28-42) who developed increased glomerular filtration were recruited in this study. The specific objectives were: 1. to study the beneficial effect of angiotensin converting enzyme inhibitor on the glomerular filtration, 2. to evaluate the effect of this treatment on blood pressure and hemodynamic parameters in normotensive, diabetic subjects. After a placebo period of one week, patients were treated orally a daily dose of 3 x 6.25 mg of captopril for twelve weeks. Glomerular filtration was assessed by the isotopic clearance method and blood pressure recordings were taken every 30 minutes throughout a day using an automatic programmable device. Preload, afterload and linear ejection fraction were estimated by echocardiograph, whereas cardiac index was measured by isotopic first pass technique. At the end of the treatment period a significant decrease of glomerular filtration was observed (from 141.9 +/- 10 ml/min to 98.9 +/- 12 ml/min; p < 0.01. Similarly, the afterload exhibited a significant drop due to drug treatment (45.6 +/- 5.8 x 10(3) dyn/cm2 vs. 55.4 +/- 4.7 x 10(3) dyn/cm2 at the end of the placebo period (p < 0.01). However, preload, linear ejection fraction, and cardiac index did not significantly change during the treatment. According to the results obtained from this study a beneficial effect of captopril on the early development of the glomerular hyperfiltration was demonstrated in normotensive diabetic patients who did not develop microalbuminuria. This issue needs to be investigated further in a large scale clinical trial.

[The role of transesophageal echocardiography in the detection of coronary anomalies and anatomical variations]. / A transoesophagealis echokardiográfia szerepe a koszorúér fejlödési rendellenességek és anatómiai variációk kimutatásában.

OBJECTIVES: The aim of the study is to examine the role of transesophageal echocardiography (TEE) in the diagnosis of anomalies and anatomic variations of the coronary arteries. BACKGROUND: In the past, coronary angiography was the only method for diagnostic confirmation in all cases with coronary anomalies, but even during invasive procedures diagnostic difficulties could and can emerge. The different, varying origin of aberrant coronary arteries can prolong the diagnostic procedure, therefore can increase the irradiation time. So every method which seems to be suitable for diagnosis of suspected coronary anomalies can be helpful. METHODS: The origin and course of anomalous coronary arteries were studied by TEE and coronary angiography during a six-month period. RESULTS: We found 16 patients (2.8%) with coronary anomalies or variations by angiography, the diagnosis of which was technically difficult. Seven of these had TEE examination too. All seven anomalous origins proven angiographically and 2 of the 2 anomalous courses in the relation to the great vessels were diagnosed by TEE. (In two, the left circumflex originated from the right sinus of Valsalva, in two we found anomalous separate origin of left circumflex coronary artery from the left sinus, in another two a common ostium of the left anterior descending and circumflex artery from the left sinus and in one an accessory artery from the non-coronary sinus.) CONCLUSIONS: TEE in a useful test to diagnose the origin of anomalous coronary arteries and confirming their course in relation to the great arteries.

[Pseudoaneurysm of the thoracic aorta diagnosed by transesophageal echocardiography]. / Transoesophagealis echokardiográfiával diagnosztizált thoracalis aorta pseudoaneurysma.

Transesophageal echocardiography is a sensitive and specific procedure that gives one of the best opportunities to examine thoracic aortic anatomy and blood flow. The non-traumatic disruption of the aorta is a life threatening injury that requires rapid diagnosis and treatment. Two cases are presented which were shown to have pseudoaneurysm of the thoracic aorta by noninvasive methods. The etiologic factor was atherosclerotic vascular disease in both cases. We performed transesophageal echocardiography first and confirmed the diagnosis by gated magnetic resonance imaging and by autopsy. These cases highlight the value of techniques such as these to reliably asses the heart and great vessels without the need of more invasive procedures.

[Ergometric, hemorheologic and myocardial perfusion studies and their evaluation by pattern recognition method in ischemic heart disease]. / Ergometriai, haemorheologiai és szívizom-perfusiós vizsgálatok értékelése sokváltozós alakfelismerö módszerrel ischaemiás szívbetegekben.

A large number of noninvasive and invasive methods are used in establishing the diagnosis of ischemic heart disease. Coronary angiography is an expensive method and a restricted capacity exists in Hungary. The aim was to elaborate an optimal combination of different noninvasive methods which can select the real positive cases for coronary angiography with maximal efficiency. Besides routine examinations, dobutamine pharmacological test was carried out and hemorheological parameters were also determined. After evaluating the results, patients were divided into three groups: absence of IHD, probable IHD and IHD. The clustering of patients into these groups was made by using their multivariable classifier algorithm (PRIMA) and 27 different parameters of 44 patients were taken into account. The groups were well separable as the class-distances indicated. The maximal ST segment depression during exercise, pharmacological test and hemorheological parameters were found to be the most powerful discriminating factors. Though the validation of the results is still in progress, based on their previous data they feel that the examination of hemorheological parameters and the application of pattern recognition method can be useful in the diagnosis of ischemic heart disease.

Effect of regular training on the anthropometric parameters and urine steroids in childhood.

The changes in the anthropometric data and urine steroid metabolites caused by regular training in children in two age groups (11 and 14 years old) were investigated. The skinfolds of older girls participating in regular athletic, swimming or soccer training were thinner compared with age-matched control groups (P < 0.01) and their body mass and constitution were lower (P < 0.05). In the other groups no significant differences were observable in the anthropometric parameters. The trained children in all groups had significantly higher exercise times on the cycle ergometer (P < 0.01, in young boys P < 0.05). The strength of their hands was lower in three trained groups: in younger boys (P < 0.05), in younger girls (P < 0.01) and in older girls (right hand P < 0.01, left hand P < 0.05). The urinary excretion of androsterone (P < 0.02), 11-ketopregnanetriol (P < 0.01) and pregnenetriol (P < 0.02) was decreased in the older trained girls; pregnenetriol was increased in younger boys (P < 0.05). Urinary excretion of cortisol metabolites was increased in trained boys [in younger boys: tetrahydrocorticosterone (P < 0.05) and 20 alpha-hydroxycortisol (P < 0.05); in older boys allotetrahydrocortisol (P < 0.02), cortisol (P < 0.05) and 20 alpha-hydroxycortisol (P < 0.05)]. There were no significant differences in the younger girls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of the cold pressor test in healthy and hyperacid subjects.

The aim of this study was to estimate the effects of the cold pressor test (CPT) on hemodynamic changes and to analyze the differences in the changes between normal and hyperacid subjects. Twelve healthy volunteers and 12 hyperacid patients were studied. The different hemodynamic parameters (basic impedance, ZO; heart rate, HR; systolic and diastolic blood pressure, RRs and RRd; ventricular ejection time, VET; stroke volume, SV; cardiac output, CO; rate-pressure-product, RPP) were measured and calculated with the impedance cardiographic method (ICG). The changes of hemodynamic parameters (HR, RRs, RRd, VET, SV, CO, RPP) were well-recorded by this method. The data were analyzed with unpaired t-tests and the multivariate statistical method, pattern recognition by independent multicategory analysis (PRIMA). There were significant differences in changes of ZO, HR (P < 0.05), RRs, RRd, SV, CO and VET (P < 0.01) and subjects in the normal and hyperacid groups could be well separated by the PRIMA method.

[Multistep prognosis in acute myocardial infarction using the PRIMA method (Pattern Recognition by Independent Multicategory Analysis)]. / Friss myocardialis infarctusban szenvedö betegek többlépcsös prognosztizálása PRIMA módszerrel.

Authors analysed the possibilities of in-hospital prognosis made of patients with acute myocardial infarction by using information obtained during admission. Eighty eight patients with transmural myocardial infarction (not older than 70 years and the prehospital delay shorter than 24 hours) were analysed. On the basis of the hospital events they were divided into 3 classes: (a) uneventful (16), (b) complicated (55) and (c) lethal (17). The initial 26 data available in the first hour were analysed by PRIMA pattern recognition method adapted to ROSY--80B microcomputer. 3 days later the 3 class distances of the initial PRIMA analysis together with the 21 new data of the remaining 79 patients were analysed again. The third analysis (66 patients) was made between the 4th and 6th days after a successful mobilization. The last analysis (44 patients) was performed just before the discharge of the patients, who were able to carry out the low-level and submaximal ergometric tests. The average effectiveness of the method gradually improved during hospitalization from 80% to 91%. The recognition ability of each class respectively was 57% for (a) uneventful, 82% for (b) complicated, and 95% for (c) lethal initially, and it has improved finally: 82% for uneventful, 94% for complicated cases.

[Hemorheologic parameters during the 6 months following myocardial infarct]. / Haemorheologiai paraméterek alakulása a myocardialis infarctust követö fél évben.

It is verified that rheological factors play a role in the pathomechanism of ischemic heart disease (IHD) and acute myocardial infarction (AMI). The changes of the rheological parameters (whole blood and plasma viscosity, fibrinogen level, hematocrit) of 17 patients (mean age: 59 years) were studied in the first six months after AMI. The measurements were carried out after the admission, before the discharge from the hospital and at the control examinations after one and six months. A slight increase of hematocrit and whole blood viscosity was found during the six months follow up period which was statistically significant concerning the hematocrit (p less than 0.05). As the part of the control examination exercise stress test was performed. Among the rheological parameters hematocrit and whole blood viscosity of those who showed myocardial ischemia during the test were significantly worse (p less than 0.05) comparing to the non ischemic group. These results underline the role of hemorheological parameters as risk factors in these diseases.

Pattern recognition in evaluation of haemorheological and haemodynamical measurements in the cardiological diagnostics.

The non-invasive differential diagnosis of ischaemic heart disease (IHD) and acute myocarditis or secondary cardiomyopathy following myocarditis can be difficult on the basis of the complaints, resting and exercise ECG and nuclear cardiological tests. 92 patients (mean age: 46 years) in the first step and 100 patients (mean age: 44 years) in the second step all with heart troubles, were examined. Besides determination of the routine parameters, nuclear haemodynamical and haemorheological measurements were carried out. Then each group of the patients was classified into 4 subgroups: 1) myocardial infarction /n:9/, 2) IHD /52/, 3) myocarditis /28/, 4) chronic cor pulmonale (CCP) /3/ subgroups in the first group and 1) normal /n:20/, 2) IHD /50/, 3) myocarditis /16/, 4) chronic cor pulmonale /14/ subgroups in the second group. The patients were reclassified by our multivariate pattern recognition algorithm (PRIMA). The average effectiveness of our method was over 80%, the recognition abilities for the subgroups (classes) ranged between 71 and 100%. An analysis of the discrimination power of the properties has made it evident that the haemorheological features were more characteristic than the haemodynamic ones in distinguishing the two differential-diagnostically critical groups. Our results show that our multivariate statistical method can be useful for the computer-aided decision in cardiological diagnostics.

Promising reduction of ventricular fibrillation in experimentally induced heart infarction by antioxidant therapy.

Studies were undertaken using a synthetic free radical scavenger (MTDQ-DA) on regional ischaemic dog hearts; it was found that the rate of malignant ventricular arrhythmias and fibrillation after coronary ligature unexpectedly decreased. According to experiments on 22 dogs, the intravenous MTDQ-DA therapy decreases the unfavourable ECG consequences of left anterior descending branch ligature: already 5 to 10 minutes after drug administration the ST segment elevation, the QT interval lengthening and the occurrence of ventricular extrasystoles and salvos are diminishing. The so-called epicardial ST map ameliorates rapidly. MTDQ-DA as a blocking agent of free radicals is able to prevent the irritative stimuli around and in the border zone of an infarct, has a vigorous anti-arrhythmogenous effect and greatly reduces the electric heterogeneity. These unexpected results may lead to a promising therapy for the acute heart infarction.

Epicardial ECG signals following global myocardial ischaemia.

Experiments were performed on 10 dog hearts undergone 15 to 90-minute normothermic arrests and 60-minute reperfusion in a special heart-lung model. The purpose of the experiments was to characterize the global ischaemic effects recorded on epicardial electrograms. The duration of QRS complexes and of RR intervals, the integral of ST segment shifts (sigma ST), the number of points showed ST segment displacements (NoST) and the ST segment isopotential map obtained by computer control were evaluated. Only a minor ST segment deviation, a small increase in duration of QRS complexes and of RR intervals with bradycardia and a tendency to electrical stability were found after global ischaemic influences. These observations indicate that pathological electrical manifestations occurring after a global ischaemia are less serious than those occurring after a focal ischaemia.