Prognostic Significance of Atrial Fibrillation in Lower Limb Amputee Patients.

OBJECTIVE: In patients with risk factors or established atherothrombosis, atrial fibrillation (AF) is associated with a poor prognosis compared with patients without AF. The aim of this study was to evaluate the prevalence of AF in patients with lower limb amputation (LLA) and its association with cardiovascular death and adverse cardiovascular events in long-term follow-up. METHODS: Observational prospective study of consecutive patients after index major (transfemoral and transtibial) LLA. The primary endpoint was cardiovascular death and secondary endpoint was a composite of adverse cardiovascular events at follow-up (acute myocardial infarction, contralateral lower limb amputation, and ischaemic stroke). RESULTS: Of 282 patients with LLA, 46 (16.3%) patients had AF. AF patients were significantly older compared with patients without AF (median 74.0, IQR 13.0 vs. median 67.0, IQR 14.8 years, p < .001). Diabetes and smoking on the other hand were significantly less prevalent in patients with AF compared with those without AF (41.3% vs. 72.0%, p < .001 and 56.5% vs. 76.3%, p = .01, respectively). 54.3% of patients with AF were on oral anticoagulation therapy. At a median follow-up of 24.0 months (IQR 19.0-32.0), 28.3% patients with AF died of cardiovascular causes versus 17.8% without AF (HRR 1.8, 95% CI 1.0-3.4, p = .06). Adverse cardiovascular events occurred in 32.6% of patients with AF during follow-up versus 22.0% without AF (HRR 1.9, 95% CI 1.0-3.3, p = .03). In multivariate Cox regression analysis, AF (HRR 2.3, 95% CI 1.3-4.2, p = .01) and diabetes (HRR 2.1, 95% CI 1.1-3.9, p = .02) were identified as independent predictors of adverse cardiovascular events during the follow-up. CONCLUSION: AF is common in patients with LLA and associated with higher risk of adverse cardiovascular events during long-term follow-up.

The importance of defining serum MMP-9 concentration in diabetics as an early marker of the rupture of atheromatous plaque in acute coronary syndrome.

Acute coronary syndrome (ACS) is the main cause of mortality in diabetics. Acute myocardial infarction (AMI) in diabetics is much more often than in non-diabetics. MMP-9 activity could ease the formation of atherosclerosis, destabilization and plaque rupture as well as thrombocyte aggregation. THE AIM OF THIS STUDY IS TO EXAMINE: MMP-9 defining in serum in diabetics; the impact of diabetes mellitus on atherosclerosis and MMP-9 level; relation between serum values of MMP-9 and markers of glycoregulation and lipid status, respectively. RESULTS: The greatest concentration of both total and active MMP-9 serum has been noted in diabetics group with ACS. Both total and active MMP-9 values, in group with diabetes and ACS showed significantly important difference regarding the values in control group. Total and active MMP-9 showed statistically important correlation between the values of glycated hemoglobine A1c (HbA1c) and inverse correlations with values of subfraction HDL3.Active MMP-9 showed statistically important inverse correlation with value of HDL cholesterol. IN CONCLUSION: According to the results, it has been thought that active MMP-9 shows a certain degree of atherosclerotic changes on blood vessels better than total MMP-9. MMP-9, active one, could present an early marker of atherosclerosis, especially on coronary blood vessels, in diabetics with type 2.

[Clinical picture of cardioborreliosis: from AV block to perimyocarditis]. / Klinicki oblici kardioborelioze: od A-V bloka do perimiokarditisa.

The third degree A-V heart block with severe Adams-Stokes attacks in nine patients with Lyme borreliosis was described. All patients had similar clinical picture: previously healthy with syncope as abrupt onset of the disease. Data on skin changes--erythema migrans--were obtained subsequently although the patients did not recall being bitten by a tick. Diagnosis was based on clinical manifestation, and on positive serologic tests to Borrelia. After the administered therapy (on admission atropine 0.5 mg i.v., and/or isoproterenol 0.02 mcg/kg/min, temporary pace-maker in two patients; and after proved diagnosis penicillin 20 mil. unit per day 10 days, and tetracyclin 2.0 gr per day 20 days A-V block returned to sinus rhythm with normal A-V conduction, and all biochemical parameters returned to normal limits. Perimyocarditis is not rare during Lyme borreliosis, but in this case infection syndrome is dominant.

[Beta blockade in acute myocardial infarction]. / Betablokatori u akutnom infarktu miokarda.

In this review article the results of randomised studies of intravenous administration of beta blockers in patients with myocardial infarction (MI) are presented. Intravenous beta blockade followed by oral, within 12 hours (preferably 6) of the onset of chest pain results in: marked reduction in chest pain, limitation of infarct size, diminished likelihood of threatened infarction progressing to overt infarction, reduction in the number of life threatening ventricular arrhythmias and reduction in the incidence of cardiac arrest and reinfarction. A pooled analysis showed that in the 14 reviewed randomized trials the overall reduction of mortality was 13.0% in the beta-blocker patients compared to control patients. Such an intervention, provided contraindications to beta blockade are respected, is safe and well tolerated. Probably, about 50.0% of patients are eligible for such treatment.