Assessment of release factors of b-type natriuretic peptide during the exercise test in patients with diabetes and after myocardial infarction with preserved left ventricular systolic function.

INTRODUCTION: The increased concentration of B-type natriuretic peptide (BNP) is an expression of overload of the heart, regardless of the cause. Exercise test is a helpful method of assessing the exercise tolerance and myocardial ischemia. THE AIM: The aim of the study is to determine the factors that cause the release of BNP during the exercise test. MATERIAL AND METHODS: The study included 99 patients with diabetes and after myocardial infarction with preserved left ventricular ejection fraction (EF≥40%). Before performing the exercise test (ExT) echocardiography was performed and blood sample was taken to determine BNP. Immediately after the exercise test another blood sample was taken to determine BNP. RESULTS: In 22 patients (22%) an increase in BNP ≥35pg/ml after the exercise test was observed. In patients with EF.

The effect of exercise on the secretion of B-type natriuretic peptide in the groups of patients with diabetes and myocardial infarction with preserved left ventricular systolic function.

OBJECTIVE: 1. Evaluation of the impact of physical exercise on the secretion of type B natriuretic peptide (BNP) in patients with preserved left ventricular function, in the group after myocardial infarction and in the group with diabetes. 2. Evaluation of the effect of hemodynamic parameters and exercise tolerance on BNP secretion in the study groups. 3. Comparison of echocardiographic image, biochemical changes and exercise tolerance in both groups. MATERIAL AND METHODS: The study included patients with type 2 diabetes without a history of myocardial infarction and patients after myocardial infarction treated with primary angioplasty, with preserved left ventricular systolic function (LV EF ≥ 40%). The study included 99 patients, aged 40-75. Patients had an echocardiographic test performed for systolic and diastolic left ventricle function evaluation, an electrocardiographic exercise test and blood collection for BNP determination before and immediately after the exercise test. RESULTS: The increase of BNP release after exercise was observed in both groups: in the group with a history of myocardial infarction, the BNP increase was 37.8 ± 45.9 pg/ml, whereas in the group with diabetes 18.1 ± 26.8 pg/ml. BNP after exercise and increase in BNP during exercise was significantly higher in subjects with a history of myocardial infarction (p = 0.008). There was no association between exercise-induced increase in BNP and the duration of exercise or exercise tolerance. Exercise tolerance was higher in subjects with a history of myocardial infarction, but the difference did not reach a statistical significance (METS 8.7 ± 3.3 vs 7.92 ± 2.3; p = 0.08). CONCLUSIONS: 1. During the exercise test an increase in BNP secretion was observed in subjects with diabetes and with the history of myocardial infarction, with preserved LV systolic function. 2. BNP growth during exercise test was significantly higher in patients after myocardial infarction. 3. The exercise-induced BNP growth did not significantly correlate with exercise duration or exercise tolerance measured with the metabolic equivalent - METS.

The effect of left ventricular diastolic function on the secretion of B-type natriuretic peptide at rest and directly after exercise test in asymptomatic patients with diabetes or after myocardial infarction with preserved left ventricular systolic functi.

BACKGROUND: Clinical evaluation of patients with diabetes or after myocardial infarction (MI) with preserved left ventricular (LV) systolic function is not very precise in isolating patients at particularly high risk of developing manifest cardiac failure and associated cardiovascular incident. Early diagnosis of LV diastolic dysfunction is essential because implementation of the appropriate treatment can positively affect the course of the disease. AIM: To assess the impact of LV diastolic function on B-type natriuretic peptide (BNP) concentration at rest and immediately after exercise test, and to search for the relationship between LV diastolic function and BNP secretion, tolerance, and duration of exercise in the studied groups of patients. METHODS: Ninety-nine consecutive patients were qualified for the study: in Group 1 - patients with type 2 diabetes without a history of MI, and in Group 2 - patients after MI with preserved LV systolic function (ejection fraction ≥ 40%), without diabetes. The studied patients had echocardiography with LV systolic and diastolic function evaluation, an electrocardiographic exercise test and blood sampling for BNP determination before and immediately after exercise test. RESULTS: The study included 99 patients aged 40-75 years (60 patients after MI and 39 patients with diabetes). The study group included 62 patients who were diagnosed with diastolic dysfunction. Diastolic dysfunction occurred in 41 (68.4%) patients in the group after MI, and in 21 (53.8%) patients in the group with diabetes, severe disorders in the form of pseudonormal and restrictive mitral valve inflow occurred in 13 (21.7%) and five (12.8%), respectively. The average BNP concentration in patients with severe diastolic dysfunction at rest was 188.3 vs. 25.2 pg/mL in patients with normal diastolic function (p < 0.001). In all patients with severe diastolic dysfunction BNP after exercise was 285.2 vs. 37.5 pg/mL in patients with normal diastolic function, and the increase in BNP during exercise was 96.9 vs. 12.4 pg/mL, respectively. Duration of exercise and exercise tolerance in patients with normal diastolic function was better in comparison with the studied patients with disturbed diastolic function, but did not reach statistical significance. CONCLUSIONS: The BNP initial concentration and its value immediately after exercise were significantly higher in subjects with severe diastolic disorders than those in subjects with normal LV diastolic function and in subjects with impaired LV relaxation.

Blood pressure load in adults with treated hypertension.

BACKGROUND AND AIM: To assess blood pressure (BP) load in a population of treated hypertensive patients. METHODS: The study group consisted of 137 hypertensive adults, including 75 (54.75%) men and 62 (45.25%) women, with either formerly or newly diagnosed hypertension based on office BP measurements. The median age in the whole study group was 52 years (47 and 56 years among men and women, respectively). The mean body mass index (BMI) was 27 ± 4 kg/m², and median duration of hypertension was 3 years. We divided the study group into subgroups depending on age, gender, BMI, and duration of hypertension. All patients underwent single 24-h ambulatory BP monitoring. We calculated 24-h, daytime and nighttime BP loads separately for systolic and diastolic BP. Statistical analysis was carried out using the SPSS 15.0 environment. RESULTS: Men were significantly younger than women (48.17 vs. 55.48 years, p < 0.02). Mean BMI was higher in men than women (28 vs. 26 kg/m², p < 0.044). There were no differences in the mean values of BP load depending on gender, BMI and, duration of hypertension (p = NS). Twenty-four hour and daytime diastolic BP load was higher in patients aged 41-65 years than in patients above 65 years (32.4 vs. 20.8%, p < 0.04; and 29.6 vs. 17.5%, p < 0.03). A negative correlation was found between daytime diastolic BP load and age (r = -0.19, p < 0.026) and a positive correlation was found between night time systolic BP load and age (r = 0.24, p < 0.005). CONCLUSIONS: There was no relationship between BP load and gender, BMI, and duration of hypertension. Diastolic BP load was age-related. Middle-aged patients were characterised by significantly higher values of 24-h and daytime diastolic BP load than the elderly patients.

Propafenone overdose: cardiac arrest and full recovery.

Intoxication caused by propafenone is very rare, and there are no known detailed epidemiological studies. We present the clinical manifestation of severe propafenone intoxication,successfully treated in a 17 year-old male. He was brought to the Intensive Care Unit after he had taken 3.0 g propafenone. The main clinical findings included: sudden cardiac arrest, coma, hypotension, left ventricular failure, bradycardia, sinoatrial block, atrioventricular junctional or/and ventricular tachycardia. During the treatment, transient heart pacing was performed and catecholamines were administered by means of continuous intravenous infusion of pressure doses as well as of infusion liquids. Cessation of toxic signs four hours after admission to hospital was observed. This relatively rare, fully symptomatic intoxication with propafenone deserved to be presented due to the drug's common usage in the treatment of dysrhythmia and life-threatening symptoms of overdosing. The course of the disease was dramatic and the patient survived only thanks to quick resuscitation, artificial ventilation, transient heart pacing, acidosis treatment and administration of pressure doses of catecholamines.

Myocarditis - clinical course and 2-year outcome in 32 patients.

BACKGROUND: Acute myocarditis is one of the most challenging diagnoses in cardiology. It is a disease with variable clinical presentation, progression and outcome. AIM: To assess clinical characteristics and outcome of patients hospitalised with diagnosis of acute myocarditis from year 2006 to 2008. METHODS: We analysed hospital files of consecutive 32 patients admitted to our hospital due to myocarditis. All demographic, clinical and laboratory data were analysed and compared between patients with acute or subacute myocarditis. After discharge the patients were followed for 8-24 months. RESULTS: The majority of patients were males (84%) in a mean age of 33 years. Clinical and echocardiographic parameters improved in 25 (78%) of patients during hospital stay. During follow-up decreased left ventricular ejection fraction (LVEF) was observed more often in patients with subacute than acute myocarditis (mean LVEF values of 49 vs. 61%, respectively). Patients with a subacute form of the disease more frequently required chronic pharmacological therapy and more often retired from occupational activities. CONCLUSIONS: Diagnosis of myocarditis is still challenging. Careful history taking, serial laboratory, ECG and echocardiographic examinations are helpful in therapeutic decisions making and assessing prognosis. Patient with subacute myocarditis are more symptomatic than patients with acute myocarditis.

[Clinical course of familial primary pulmonary hypertension in a 39-year-old female and her two children]. / Przebieg kliniczny rodzinnej postaci pierwotnego tetniczego nadcisnienia plucnego u 39-letniej kobiety i dwojga jej dzieci.

Primary pulmonary hypertension (PPH) is diagnosed in case of pulmonary hypertension of unexplained etiology. When PPH occurs in members of a family it should be diagnosed as familial PPH. Genetic anticipation has been described in familial PPH. We present a case of two children (4-year-old boy and 8-year-old girl) who died due to complications of familial PPH and their 39-year-old mother who has been treated due to PPH for two years. This case is interesting due to the scarcity of such reports, seriousness of the disease and genetic anticipation of familial PPH.