Plasma concentrations of TNF-alpha and its soluble receptors sTNFR1 and sTNFR2 in patients with coronary artery disease.

Tumour necrosis factor alpha (TNF-alpha) is implicated in post-ischemic myocardial dysfunction. Two distinct TNF-alpha receptors are shed from cell membranes and circulate in plasma as soluble sTNFR1 and sTNFR2 proteins. The aim of the study was to establish factors associated with plasma concentrations of TNF-alpha and its receptors in patients with coronary artery disease (CAD). Since adenosine inhibits the expression of TNF-alpha, two functional polymorphisms in genes encoding enzymes participating in adenosine metabolism, i.e. AMP deaminase-1 (AMPD1, C34T) and adenosine deaminase (ADA, G22A), were analyzed. Plasma concentrations of TNF-alpha, sTNFR1, and sTNFR2 were measured using ELISA in 167 patients with CAD. Common factors significantly associated with higher TNF-alpha, sTNFR1, and sTNFR2 were lower glomerular filtration rate (GFR), older age, higher BNP, lower blood haemoglobin, and the presence of asthma or chronic obstructive pulmonary disease (COPD). Higher TNF-alpha and sTNFR1 concentrations were also associated with the presence of heart failure (HF), lower ejection and shortening fraction, the presence of diabetes or metabolic syndrome, lower serum HDL cholesterol, and higher uric acid. In multivariate analysis the common independent predictors of higher TNF-alpha, sTNFR1, and sTNFR2 were lower GFR, lower HDL cholesterol, higher BNP, and the presence of asthma or COPD. There were no associations between AMPD1 C34T or ADA G22A genotypes and TNF-alpha or its receptors. In conclusion, the concentrations of TNF-alpha, sTNFR1, and sTNFR2 reflect the impairment of cardiac and renal function in patients with CAD. Metabolic syndrome and diabetes are associated with higher plasma concentrations of TNF-alpha and its receptors.

Atrial epicardial pacing with long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis.

Atrial epicardial pacing with a long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis is discussed. Arrhythmogenic right ventricular dysplasia (ARVD) is associated with a high incidence of malignant ventricular arrhythmias. Most patients with ARVD need antiarrhythmic drugs, catheter ablation, or an implantable cardioverter defibrillator. We report a patient with ARVD in whom effective treatment with sotalol caused severe, symptomatic sinus bradycardia requiring permanent pacing. Due to leftward displacement of the right ventricle and the presence of two thrombi in the right atrium, an epicardial atrial lead and AAI pacemaker were implanted. A long stimulus to P wave interval caused by severe dilatation of the right atrium was recorded. During a 6 months of follow-up on sotalol treatment there were neither ventricular tachycardia (VT) attacks nor pacing problems.

[Common double inlet ventricle (univentricular heart) in 27 year old man: a case report]. / Wspólna dwunaplywowa komora (serce jednokomorowe) u 27-letniego mezczyzny--opis przypadku.

We present 27-years old man with common double inlet ventricle (CV), hypoplastic pulmonary artery and transposition of the great arteries which was diagnosed in childhood. Based on echocardiographic examination we found unidentify type of CV. Patient did not have surgery and was in good condition. He has been working. We believe that main reason of his good condition is hemodynamically optimal width of the hypoplastic pulmonary artery.

[The evaluation of surgical revascularization of the left ventricular systolic function after surgery]. / Ocena czynnosci lewej komory serca po wszczepieniu pomostów aortalno-wiencowych w róznym czasie po operacji.

To determine the effects of coronary artery bypass grafting (CABG) on the left ventricular function the 83 patients aged 52 +/- 6 years with ischaemic heart disease were examined by a standard two dimensional echocardiography (ECHO) and exercise test (EXT) before CABG and 1, 3, 6, 12 month after CABG. The following parameters were measured: LV ejection fraction (LVEF) and wall motion score index (WMSI) according to 14-segmental model and the duration of exercise test with work load. In conclusion, in patients surgical revascularization can significantly improve left ventricular function 6 and 12 month after CABG. We didn't observe connection between left ventricular function and result of exercise-test.

Electrocardiographic changes after alcohol septal ablation in hypertrophic obstructive cardiomyopathy.

OBJECTIVE: To report acute and mid-term electrocardiographic changes in patients with hypertrophic obstructive cardiomyopathy (HOCM) after alcohol ablation of the first large septal branch of the left anterior descending coronary artery; and to relate electrocardiographic data with the left ventricular outflow tract pressure gradients. PATIENTS: Nine consecutive symptomatic patients with HOCM (mean (SD) age 45 (12) years). METHODS: Analysis of baseline and post-procedure ECGs and 24 hour ambulatory monitoring (up to six months). ECG data were related to left ventricular outflow tract pressure gradients. RESULTS: One patient developed complete atrioventricular block requiring permanent pacing. The PR interval was significantly prolonged up to third month after ablation. Immediately after the procedure all patients developed right bundle branch block. At the sixth month of follow up, right bundle branch block was present in four patients. New anterior ST elevation developed immediately after ablation in five of the nine patients, and new Q waves in four. The QRS duration was significantly prolonged immediately after ablation and during follow up. There was significant but transient prolongation of QT-mean and QTc-mean intervals. QT dispersion, QTc dispersion, and JTc-mean interval were not affected. JT and JTc dispersions were transiently prolonged. No serious ventricular arrhythmias were recorded during Holter monitoring, either before or after the procedure. There were no significant correlations between the left ventricular outflow tract pressure gradient and QTc, QT-d, QTc-d, JTc, JT-d, JTc-d, or QRS duration before and after ablation. CONCLUSIONS: Alcohol septal ablation for HOCM induces significant changes in the resting ECG in most patients, despite the occlusion of a relatively small artery. The changes include new Q waves, new bundle branch block, transient anterior ST segment elevation, atrioventricular block, and transient prolongation of QT interval.

[False tendons in the left ventricle--an independent arrhythmogenic factor?]. / Struna rzekoma w lewej komorze--niezalezny czynnik arytmogenny?

To assess if the presence of false tendons (FT) in the left ventricle can be an independent factor increasing the risk of ventricular arrhythmias in apparently healthy subjects, we examined 38 persons aged 18-60 years in whom during echocardiographic examination we accidently found FT in the left ventricle. No other echocardiographic disorders were present. Physical examination, ECG and stress ECG showed no symptoms of heart disease. The only ischaemic heart disease risk factor was smoking in 20 persons (in 6--more then 20 cigarettes daily). 24-hours Holter monitoring revealed single supraventricular complexes in 9 persons (34.7%). We found ventricular arrhythmias in 6 persons (15.8%): 4 (10.5%) had single, unifocal ventricular complexes, 1 (2.6%) had more (up to 6 in one minute) ventricular complexes, and 1 (2.6%) had some ventricular couplets. We observed no ventricular arrhythmias in stress ECG. We conclude, that in apparently healthy subjects with FT the frequency of ventricular arrhythmias is not higher, then in the normal healthy population.

[Echocardiographic image of the heart in physiological pregnancy and pregnancy-induced hypertension (EPH gestosis)]. / Echokardiograficzny obraz serca w ciazy fizjologicznej i powiklanej nadcisnieniem tetniczym indukowanym przez ciaza (gestoza EPH).

The aim of the paper was an attempt to perform own evaluation of the changes which in the woman's circulatory system are provoked by pregnancy, being complicated by gestation-induced arterial hypertension (gestosis H) as compared with changes occurring in physiological pregnancy. The model of the study was provided by monodimensional echography. The study covered 51 normal non-pregnant women, 43 normal pregnant women and 45 pregnant ones with arterial hypertension induced by the pregnancy (gestosis EPH). The evaluated anatomical and functional parameters permitted the estimation of the circulatory system and the direction of hemodynamic changes in the studied groups. In the group of women with physiological pregnancy I obtained the confirmation of hitherto existing viewpoints, it means, I disclosed features of the hyperkinetic circulation with the increase of the cardiac output, and the drop in peripheral resistance as well as a slight, compensatory hypertrophy of the left ventricular muscle. In women with gestosis. I revealed higher intensity with regard to the features of hyperkinetic circulation, apparent hypertrophy of the muscle of the left ventricle, its good contractility, and indirect symptoms that may evidence a defect in diastolic tendency of the left ventricle. The increment in the severity of gestosis was accompanied by a further mass increase of the left ventricular muscle.

[A case of constrictive pericarditis complicated by mitral insufficiency]. / Przypadek zaciskajacego zapalenia osierdzia powiklanego niedomykalnoscia zastawki dwudzielnej.

A case of constrictive pericarditis complicated with mitral valve insufficiency is presented. Attention is called to the haemodynamic consequences and clinical effects of the coexistence of both these conditions and decidedly favourable effect of surgical treatment.

[Function of the left cardiac ventricle in "pure" aortic insufficiency prior to and following valve replacement with a biological prosthesis]. / Czynnosc lewej komory serca w "czystej" niedomykalnosci zastawki aorty przed i po wszczepieniu zastawki biologicznej.

Contractibility of the left ventricle was investigated in 15 patients with chronic aortic insufficiency with class II and III NYHA lesions. The patients were examined prior to and 6 months-2 years after valve replacement with biological prosthesis. The following parameters have been determined: end-systolic and end-diastolic left ventricular volumes, ejection fraction, mean rate of circular muscle fibers shortening, and segmental contractibility of the left ventricle. Valve replacement with biological prosthesis improved contract ability of the left ventricle in the great majority of the operated patients with chronic aortic insufficiency. Assessed parameters did not correlate well with those obtained following valve replacement.

[Constrictive pericarditis as a cause of circulatory failure in a pregnant woman]. / Zaciskajace zapalenie osierdzia jako przyczyna niewydolnosci krazenia u ciezarnej.

A case is reported of severe circulatory failure in a pregnant woman caused by previously unrecognized constrictive pericarditis. The effect of haemodynamic changes characteristic of pregnancy on the manifestation of the disease end the importance of echocardiography as a diagnostic method of choice is stressed in cases of cardiac diseases in pregnancy.

[Arrhythmogenic dysplasia of the right ventricle-- clinical picture in view of the literature and personal experience]. / Arytmogenna dysplazja prawej komory--obraz choroby na podstawie pismiennictwa i obserwacji wlasnych.

The author discusses arrhythmogenic dysplasia of the right ventricle, a disease of unclear etiology characterized by the replacement of right ventricular muscle with the connective tissue and ventricular cardiac arrhythmias. Clinical symptoms, available diagnostic techniques and treatment are reviewed. Four case reports illustrate arrhythmogenic dysplasia of the right ventricle.