Microvolt T-wave alternans predicts cardiac events after acute myocardial infarction in patients treated with primary percutaneous coronary intervention.

BACKGROUND: Current risk stratification after acute myocardial infarction (MI) depends on left ventricular ejection fraction. Microvolt T-wave alternans (MTWA) is one of promising markers to predict cardiac events in patients after acute MI treated according to current guidelines. METHODS: In this single center study, 112 consecutive patients with the first anterior ST-elevation MI undergoing PCI <12 hours from symptom onset, were enrolled prospectively. Demographics, established risk factors, myocardial contrast echocardiography (MCE) perfusion, index event data and MTWA were assessed. Composite cardiac events (CCE) defined as: death, recurrent MI, sustained ventricular tachycardia (sVT) or readmission for acute heart failure (HF) were recorded during follow-up. RESULTS: MTWA test was negative in 76, positive in 18 and undetermined in 7 patients. MTWA negative patients had significantly higher LVEF at 30 days. At 4 years, 26 patients experienced CCE (10 died, 2 reinfarcted and 14 HF events). In multivariate Cox proportional hazard model maximum CKMB, non-negative MTWA and reduced LVEF made the best model to predict CCE. Four year CCE free survival was 77% and was significantly lower for non-negative MTWA (94% vs 50%, p<0.003). CONCLUSIONS: Non-negative MTWA with infarct size index and reduced LVEF could predict cardiac events in patients with anterior STEMI treated with primary PCI. MTWA non-negative patients have significantly worse outcome.

[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.

[Sick sinus syndrome (extrinsic and intrinsic form) during long term observation]. / Obraz kliniczny zespolu chorego wezla zatokowego (postac czynnosciowa i organiczna) w czasie wieloletniej obserwacji.

UNLABELLED: The aim of the study has to be find, on basis of long term follow-up, an independent factors determining of pacemaker implantation in patients with intrinsic and extrinsic form of sick sinus syndrome. The second point was to find an independent risk factors of stroke and another serious complication in this group of patients (specially in paced group). The study group consisted 169 pts with sick sinus syndrome (in all pts abnormal electrophysiological tests--transoesophageal atrial stimulation). The form of sinus node dysfunction (extrinsic or intrinsic) was determined on basis of electrophysiological study after pharmacological denervation of the heart (propranolol and atropine i.v. in doses 0.2 and 0.04 mg/kg body weight respectively). The statistical analysis was performed on all pts (97 men and 72 women 48 +/- 16 yrs old) using Cox's model of proportional hazardous analysing. The follow-up period ranging from 14 to 84 months (mean 49.9 +/- 19). Pacemaker was implanted in 88 pts during observation period. Stroke signs were found in 7 pts including 6 pts after pacemaker implantation. There was 13 death (7 sudden or primary neurological death). CONCLUSIONS: 1) independent factors of pacemaker implantation were syncope, age and persistent bradycardia, 2) form of sinus node dysfunction was not an independent factor of this decision, 3) age (older), persistent after pacemaker implantation syncope and registered in transesophageal ecg ventriculo-atrial condition were independent risk factors of stroke in pts with VVI stimulation, 4) despite of pacemaker implantation (VVI mode) many patients have presyncopal or syncope attacks but life comfort in this group was much better then before implantation.

Synthesis and biological activity in the GPI test of scyliorhinin I and its Val7 and Ile7 analogs.

Scyliorhinin I, a decapeptide, of tachykinin family, and its two analogs containing Val or Ile in position 7, have been synthesized using the solid-phase method, and tested for agonistic activity on isolated guinea pig ileum. Both analogs were slightly more active than scyliorhinin I, but they were significantly less potent than substance P.