QT interval dispersion as a new marker of restenosis after percutaneous transluminal coronary angioplasty of isolated single-vessel coronary artery stenosis.

BACKGROUND: There are no reliable non-invasive markers of restenosis after percutaneous transluminal coronary angioplasty (PTCA). The aim of our study was to measure changes in QT interval dispersion after PTCA and to determine whether restenosis subsequently affects QT interval dispersion. METHODS AND RESULTS: Fifty-six consecutive patients - 41 men and 15 women (mean age: 56.2 +/-8.3 years) - with isolated stenosis of the left anterior descending artery who underwent successful PTCA were studied. A symptom-limited treadmill exercise test was performed within 7 days after PTCA and then again before repeated angiography. Repeated coronary angiography revealed restenosis in 15 patients (26.8%) and no signs of significant stenosis in 41 patients (73.2%). QT interval dispersion in the group of patients with restenosis measured before exercise increased from baseline 34 +/- 7 to 49 +/- 15 ms after 6 months (p < 0.01) and QT interval dispersion measured immediately after exercise increased from baseline 38 +/- 4 to 68 +/- 21 ms after 6 months (p < 0.001). In contrast, patients without restenosis showed no significant changes in QT interval dispersion measured before (baseline: 34 +/- 9 ms; after 6 months 33 +/- 12 ms; p = NS) and immediately after exercise (baseline: 34 +/- 12 ms; after 6 months: 33 +/- 10; p = NS). When QT interval dispersion > or =60 ms (measured 6 months after PTCA procedure) was considered as a potential marker of restenosis, this indicator had very high sensitivity and specificity when measured immediately after exercise (80 and 95% respectively). CONCLUSIONS: QT interval dispersion significantly increases in the group of patients with documented restenosis and may be a simple, non-invasive marker of restenosis. However, further studies are needed to confirm this observation.

Effect of restoration of AV synchrony on stroke volume, exercise capacity, and quality-of-life: can we predict the beneficial effect of a pacemaker upgrade?

The aim of this study was to assess to what extent patients with VVIR pacemakers and without overt symptoms of a pacemaker syndrome benefit from a pacemaker upgrade, and if a preoperative noninvasive measurement of the change in stroke volume (SV) could predict the effect of a pacemaker upgrade. The study group consisted of 20 (12 women, 8 men) VVIR patients with a mean age of 60 years. The indication for the first implantation was AV block in 13 patients and SSS in 7. The mean time of a ventricular pacing was 77 months. The objective (echocardiography, an exercise capacity) and the subjective (the quality-of-life) parameters investigated in patients during ventricular pacing were compared to results obtained 2 months and 1 year after a pacemaker upgrade. To assess preoperatively a change in a SV expected after upgrading, attempts were made to restore AV synchronization by the use of a transesophageal pacemaker. An increase in SV (from 5% to > 35%) during temporary AV resynchronization was observed in each patient. Values of SV increase correlated with those obtained 2 months (r = 0.65; P < 0.01) and 1 year (r = 0.66; P < 0.01) after an upgrade. Superior hemodynamics was associated with a significant improvement of an exercise capacity in both subgroups of patients. The most significant improvement in the quality-of-life was observed in patients with SSS. We did not find correlations between SV and the quality-of-life assessed 2 months (r = 0.043; NS) or 1 year (r = 0.02; NS) after an upgrade. In conclusion, a pacemaker upgrade performed after a long-term ventricular pacing resulted almost consistently in the improvement of hemodynamics and was associated with an increase of exercise capacity. In patients with SSS it was followed by the significant improvement of their quality-of-life. Such a relation was not observed in patients with AV block as some of them (especially those with VVIR pacemakers) felt quite well during ventricular pacing. The proposed preoperative echocardiographic evaluation may precisely predict the degree of hemodynamic improvement expected after a pacemaker upgrade.

[Arterial hypertension complicated by aortic dissection. Clinical analysis, results of conservative treatment]. / Nadcisnienie tetnicze powiklane tetniakiem rozwarstwiajacym aorty. Analiza kliniczna, wyniki leczenia zachowawczego.

Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.

[Evaluation of the antihypertensive efficacy of urapidil in the treatment of hypertension emergencies]. / Ocena skutecznosci hipotensyjnej urapidilu w leczeniu przelomu nadcisnieniowego.

Hypertensive crisis is defined as an acute elevation of the blood pressure involving the risk of life. Agents used to the treatment of hypertensive emergencies should lower the blood pressure under control and produce minimal adverse effect. The aim of this study was to evaluate the antihypertensive efficacy of urapidil i.v. in hypertensive emergencies. Twenty three patients (pts) with the hypertensive crisis in association with ischaemic heart disease and/or acute left ventricular failure were studied. Urapidil was given intravenously in the emergent treatment to the group of 23 pts in the mean dose of 50 mg. Systolic (RRs) diastolic blood pressure (RRd) and heart rate were measured within 4 hours after the drug administration. In this group of pts the significant decrease in RRs and RRd after 2 min. of administration of urapidil was observed and the maximum effect (p < 0.05) occurred within 40 min. The heart rate decreased by 8% and was significantly different (p < 0 > 05) at the maximum point of the drug action. Urapidil administered in 25-75 mg i.v. appeared an effective antihypertensive agent in more than 90% of patients with hypertensive emergencies. What was striking, no reflex tachycardia was observed after i.v. administration of urapidil despite its antihypertensive action.

Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.

UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

[Unusual clinical course of ruptured aortic aneurysms--reports of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadów.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Unusual clinical course of ruptured aortic aneurysms--report of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadków.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Ventricular arrhythmia in patients treated with diuretics]. / Komorowe zaburzenia rytmu u chorych leczonych lekami moczopednymi.

A quantitative and qualitative analysis of ventricular arrhythmia was performed in 120 patients (64 men and 56 women, mean age 54 +/- 16) who suffered from arterial hypertension or congestive heart failure in the course of organic heart disease or ischaemic heart disease. 60 of them were treated with diuretics and the other 60 were control group. Neither antiarrhythmic drugs nor digitalis were used. There were no signs of left ventricular hypertrophy. Most patients treated with diuretics received potassium supplementation. Besides clinical examination all patients underwent 24 hours monitoring of Holter ECG. 38 patients treated with diuretics were evaluated before and after 6 months of therapy. In the diuretic group significantly higher percentage of patients with greater density of premature ventricular beats (count of premature ventricular beats [PVB]/100,000 heart evolutions) was observed. Number of patients with complex ventricular arrhythmia (Lown IVa and IVb) was also greater in this group. Serum levels of potassium and magnesium fell within the normal range, but the latter was significantly lower (p < 0.05) in those treated with diuretics.

[Cardiac arrhythmias during extracorporeal shock wave lithotripsy]. / Zaburzenia rytmu serca w czasie kruszenia kamieni nerkowych za pomoca fali uderzeniowej.

Holter monitoring was performed in 55 patients (24 women, 31 men), mean age 50.7 +/- 11.3 who underwent ECG-triggered extracorporeal shock wave lithotripsy (ESWL). Patients were divided into two groups A--30 with history of cardiac disease and B--25 control. The heart rate was significantly higher before and after ESWL in the first group. The number of premature ventricular contractions was higher during ESWL in the same group. No other cardiac complication was observed.