Effect of amiodarone on mortality after myocardial infarction: a double-blind, placebo-controlled, pilot study.

OBJECTIVES: The goal of this study was to evaluate the effect of amiodarone on mortality, ventricular arrhythmias and clinical complications in high risk postinfarction patients. BACKGROUND: No therapy has been shown to reduce sudden death in patients ineligible to receive beta-adrenergic blocking agents after myocardial infarction. METHODS: Patients who were not eligible to receive beta-blockers were randomized to receive amiodarone (n = 305) or placebo (n = 308) for 1 year. RESULTS: There were 21 deaths in the amiodarone group compared with 33 in the placebo group (odds ratio 0.62, 95% confidence interval [CI] 0.35 to 1.08, p = 0.095). There were two noncardiac deaths in the amiodarone group and none in the placebo group; thus, the difference in cardiac mortality (19 vs. 33, respectively) was statistically significant (odds ratio 0.55, 95% CI 0.32 to 0.99, p = 0.048). There was a significant decrease in Lown class 4 ventricular arrhythmias (7.5% vs. 19.7%, respectively, p < 0.001). Adverse effects developed in 30% of amiodarone-treated patients and 10% of placebo-treated patients. Pulmonary toxicity, which was mild and reversible, occurred in only one patient in the amiodarone group but in no patient in the placebo group. CONCLUSIONS: This trial demonstrated a significant reduction in cardiac mortality and ventricular arrhythmias with amiodarone treatment. However, given the wide confidence intervals and borderline statistical significance of our trial, larger trials are needed to confirm or refute this view.

Lack of effect of amiodarone on survival after extensive infarction. Polish Amiodarone Trial.

BACKGROUND: The purpose of this study was to elucidate whether the reduction of mortality with amiodarone after myocardial infarction depended on ejection fraction. METHODS: The data from the Polish Amiodarone Trial were analysed retrospectively. Patients with acute myocardial infarction and contraindications to beta-blockers were randomized on days 5-7 after admission to receive amiodarone (n = 305) or placebo (n = 308). Short and long-term (46 months) mortality were analysed comparing the groups with impaired (ejection fraction < 40%) and preserved (ejection fraction > or = 40%) left ventricular function. A subset of patients (n = 523) with available echocardiograms were subjected to this analysis. RESULTS: Long-term and sudden cardiac mortality were significantly reduced with amiodarone in the group of patients with ejection fraction > or = 40% (amiodarone versus placebo, respectively: 9.1 versus 16.5%, P < 0.05; 3.4 versus 8.2, P < 0.05). No beneficial effect of amiodarone was observed in the group with low ejection fraction (cardiac and sudden cardiac mortality: amiodarone versus placebo, 20.8 versus 19.3% and 7.8 versus 5.7% respectively). One-year mortality also revealed a favourable trend only in amiodarone-allocated patients with ejection fraction > or = 40%. CONCLUSION: Amiodarone decreased long-term and sudden cardiac mortality after myocardial infarction only in patients with preserved left ventricular function. No benefit was observed in patients with decreased ejection fraction.

[Transesophageal and classical echocardiography in myocardial infarction and heart valve disease (comparison study)]. / Echokardiografia przezprzelykowa i klasyczna w zawale serca i wadach zastawkowych (badanie porównawcze).

In 85 patients (22 with myocardial infarct and 63 with valvular heart disease) echocardiographical examination simultaneously by classical and transesophageal methods was done. The transesophageal method was better in assessing the aortic valve and similar to the classical method in reference to the mitral valve. Heart contractility assessment was better with the classical method. Transesophageal echocardiography is the method of choice in patients in whom classical echocardiography cannot be done (obesity, emphysema, chest deformation).

[Localization of myocardial infarction with the help of EKG and two-dimensional echocardiography. Controversies]. / Lokalizacja zawalu serca za pomoca ekg i echokardiografii dwuwymiarowej. Kontrowersje.

A multicentre study of the localization of myocardial infarction (MI) using ECG and 2-dimensional echocardiography (Echo-2D) was performed on the 21st day of the onset of MI. The study population consisted of 650 pts (mean age 55.0 years), 553 males and 97 females. The purpose of the study was: 1) to compare the site of MI as diagnosed by ECG and Echo-2D, 2) to determine the controversies in the diagnosis between these two methods. Consistent results of both methods were obtained in 408 pts (62.8%) of the group. In 61 pts (9.4%) the diagnosis of MI by ECG and Echo-2D was undefined. In 181 pts (27.8%) the inconsistencies of ECG and Echo-2D evaluations were demonstrated; in 106 pts ECG changes were undefined, but evident Echo-2D changes were found; on the contrary, in 51 pts MI diagnosed by ECG was not confirmed by Echo-2D. In 24 pts entirely inconsistent results were shown. 209 pts (32%) with myocardial contractility disorders in the apical region of the heart diagnosed by Echo-2D showed different MI localisation as determined by ECG: 147 pts had anterior or antero-lateral MI, 28 pts--postero-inferior MI, 12 pts--apical MI and 22 pts--another one. By these findings it has been shown that ECG and Echo-2D are compatible methods but not replaceable ones.

[Aneurysms in acute myocardial infarction (multicenter studies)]. / Tetniaki w ostrym zawale serca. (Badania wieloosrodkowe).

The authors present outcomes concerning frequency of appearance and clinical course of aneurysms after acute myocardial infarction. The study population consisted of 730 patients (mean age 54 +/- 9 years) with acute myocardial infarction, including 579 men and 151 women. The diagnosis was based on the following criteria: 1) coronary artery disease history, 2) physical examination, 3) ECG, 4) 2-dimensional echocardiography, 5) biochemical data. Post-infarction aneurysm was revealed in 42 patients (5.8%, 33 men and 9 women); antero-lateral aneurysm--in 36 patients (85.7%), and inferior-posterior aneurysm--in 6 patients (14.3%). Ventricular arrhythmias in the first day of infarction had a high frequency in both groups; with aneurysm--92.9%, without aneurysm--82.2%. The frequency of arrhythmia in 21-st day of infarction decreased similarly in both groups with aneurysm--40.5%, without aneurysm--38.9%. There was no statistically significant difference among both groups. There was no correlation between localisation of aneurysms and degree of contractility disturbances of the heart muscle (dyskinesis, akinesis). Heart failure--class III and IVK (Killip-Kimball classification) occurred in 19.0% of patients with aneurysm and in 10.4% of patients without aneurysm. That was no essential correlation between localisation of aneurysms and advancement of the heart failure.

[Effect of beta adrenergic blocking drugs on the prognostic value of ST-segment depression during exercise electrocardiogram testing]. / Wplyw leków beta adrenolitycznych na wartosc prognostyczna obnizonego odcinka ST w elektrokardiogramie wysilkowym.

Exercise testing has been shown to be predictive for future cardiac events in patients with established diagnosis of coronary heart disease. Exercise test parameters associated with poor prognosis may be unreliable if patient is receiving beta adrenergic agents. The purpose of this study was: 1) to compare the results of exercise testing performed before and during beta blocking therapy, and 2) to determine the role of beta blockers in the prognostic significance of the ST-segment response recorded during exercise testing. The study population consisted of 518 patients (mean age 52 +/- 7 years) with coronary heart disease. The diagnosis was based on the presence of one of the following three criteria: 1) typical history and significant ST-segment depression on resting or exercise electrocardiogram, 2) history of myocardial infarction, 3) significant coronary angiographic abnormalities. In all patients symptom-limited exercise test was performed before and two weeks after the onset of beta blocker therapy. The data from the first and second tests were estimated for significance of differences between the mean values with following results: maximal heart rate--135 +/- 21 and 123 +/- 19 bpm (p less than 0.001), maximal work load achieved--98 +/- 43 and 109 +/- 44 W (p less than 0.001), maximal systolic blood pressure--171 +/- 28 and 163 +/- 26 mmHg (p less than 0.001). Occurrence of characteristic ST-segment depression was more frequent during the first than during the second test (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of antiarrhythmic drugs on some echocardiographic parameters of left ventricular function in patients with ischemic heart disease]. / Wplyw leków przeciwarytmicznych na niektóre echokardiograficzne wskazniki czynnosci lewej komory u chorych z choroba niedokrwienna serca.

This study was performed to evaluate the effects of antiarrhythmic drugs on left ventricular function in 843 patients with ischaemic heart disease and ventricular arrhythmias (Lown classes 2-5). Rhythm abnormalities were observed by ambulatory electrocardiographic monitoring before and after 2-weeks of antiarrhythmic therapy. Haemodynamic variables such as cardiac output (CO), ejection fraction (EF), stroke volume (SV), and ratio of myocardial contractility (RMC) were derived from the cross sectional echocardiography. Efficacy of the applied drugs was 42-71%. Of these antiarrhythmic agents only propranolol caused the deterioration of left ventricular performance, measured by CO; in mono-therapy propranolol produced significant changes (p less than 0.05), in combination with amiodarone--at point of significance. Mexiletine produced significant improvement in EF and SV (p less than 0.05). There were no significant changes in haemodynamic parameters after treatment with the other drugs.

[Does the appearance of pro-arrhythmic response to anti-arrhythmic drugs have prognostic significance?]. / Czy wystapienie reakcji proarytmicznej na lek przeciwarytmiczny ma znaczenie prognostyczne?

Study was undertaken to assess whether proarrhythmic response to antiarrhythmic drug is a risk factor for cardiac death in patients (pts) with ischaemic heart disease (IHD). In 782 pts with IHD and frequent and/or complex ventricular ectopic beats (VEB) 1041 drug tests guided by 24 hour Holter monitoring were conducted. The following drugs were assessed: propranolol, disopyramide, mexiletine, amiodarone. Pro-arrhythmia was defined according to Velebit: 1/greater than or equal to 4-fold increase in VEBs, 2/greater than or equal to 10-fold increase in repetitive forms of 3/new occurrence of ventricular tachycardia or ventricular fibrillation (VT/VF). Proarrhythmic effect was observed in 8.4% of pts and in 7.9% of drug tests. The frequency with individual drugs ranged from 5.7% to 9%. No drug was completely free of this type of reaction. Antiarrhythmic drugs inducing arrhythmogenic response were eliminated. Pts were followed-up for a mean of 22 months (range 1-49). Chronic antiarrhythmic treatment was conducted. Pts were discharged taking the agent deemed most effective for suppression of arrhythmia. Follow-up visits were made every 6-12 months. All cases of death were verified. In long-term observation cardiac death and sudden death occurred in 53 and 32 pts. With actuarial analysis (Kaplan-Meler method, log rank test) there was significant difference in cardiac death (p less than 0.05) of pro-arrhythmia (+) compared with ++pro-arrhythmia (-) pts at yr (11% v 4%, 7% v 3%) and 3 yr (24% x 11%, 16% v 7%). The relative importance of baseline clinical variables in predicting survival was assessed with a stepwise Cox regression.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of nitrates on red blood cell deformability and clinical parameters in patients with silent ischemia]. / Wplyw azotanów na odksztalcalnosc krwinek czerwonych i parametry kliniczne chorych z niemym niedokrwieniem.

In 30 patients after myocardial infarctum with actual silent ischemia (no pain during last 12 months) mononitrate (Olicard 40) was administered and red blood cell deformability was determined. Clinical improvement and decrease of aforementioned deformability were observed after mononitrate therapy.

[Relation between ischemic heart disease and tobacco smoking]. / Chorobowosc na chorobe niedokrwienna serca zwiazana z nalogiem palenia tytoniu.

The incidence of ischaemic heart disease related to tobacco smoking was studied in a population of males aged 35-64 years in the Bródno District of Warsaw. The population comprised 2123 subjects (attendance rate 62%). A relationship was demonstrated between cigarette smoking in the past and the ischaemic heart disease, its incidence was twice as high in former smokers than in non-smokers. No significant difference was found in this incidence between non-smokers and present smokers. A more deep analysis shows that former smokers who quitted smoking due to intensification of clinical symptoms are frequently included into the group of non-smokers, and they are the group at highest risk for ischaemic heart disease development.

[Palpitin--an anti-arrhythmic drug in ischemic heart disease]. / Palpitin--lek przeciwarytmiczny w chorobie niedokrwiennej serca.

The effectiveness was assessed of the antiarrhythmic treatment with Palpitin in 30 patients with ischaemic heart disease (IHD). The control group comprised 15 patients with IHD and arrhythmia, treated with propranolol. In all patients ECG recording by Holter's method was done before the treatment and after 14 days of the treatment. The effectiveness of Palpitin was expressed as improvement in 66% of cases (reduction of ectopic beats by 75%), and in 40% of cases complete regression of arrhythmia was achieved. These results were slightly better than in the group treated with propranolol (improvement in 60% of cases). Palpitin during the treatment caused no increase in the manifestations of cardiac failure and produced no disturbances of atrioventricular conduction. Fairly frequently the patients complained about mucosal dryness and sporadically about dyspeptic symptoms, but these symptoms were not disturbing the course of the treatment.

[Hypertension and obesity]. / Nadcisnienie tetnicze a otylosc.

An epidemiological study was carried out in a population of men aged 35-64 years in the Bródno District of Warsaw. The study included 2123 subjects, the frequency was noted of hypertension and obesity as risk factors for ischaemic heart disease, and their correlations were studied. As hypertension the following values were accepted: --borderline hypertension = 140/90 less than 160/95 mm Hg, --stabilized hypertension = greater than or equal to 160/95 mm Hg. Overweight was accepted as Quetelet's index 29.0 weight in kg/height in cm. Stable hypertension was found in 35.0% of obese men and 18.5% of non-obese men (p less than 0.001). Borderline hypertension was demonstrated in 31.6% of obese men and 22.9% of non-obese men (p less than 0.002). Normal blood pressure was found in 58.4% of non-obese men and in only 33.4% of the obese ones (p less than 0.001). The prevalence of hypertension in obese men, both systolic and diastolic hypertension, was related to age: the highest proportion of hypertensive subjects was in the oldest group, the lowest one in the youngest group. The results agree with those reported by other authors who also demonstrated a high correlation between hypertension occurrence and increasing overweight.

[Angiogenic activity of mononuclear cells in the peripheral blood of patients with ischemic heart disease]. / Aktywnosc angiogenna komórek jednojadrzastych krwi obwodowej pacjentów z choroba niedokrwienna serca (ChNS).

In the paper the cell-mediated phase of the immune response was assessed in ischaemic heart disease (IHD). The assessment was based on the angiogenesis test in which new capillaries are formed from the already existing vascularization. The process is mediated by mononuclear cells from peripheral blood, and is induced by degradation products appearing as a result of ischaemic injury to the tissues. The test was carried out in 71 patients with IHD and in 65 clinically healthy subjects. A significant fall was demonstrated of the angiogenic activity of mononuclear cells isolated from the peripheral blood of IHD patients as compared with controls (p less than 0.001). No effect was method of disease duration, its form or treatment on angiogenesis. The obtained results may suggest a failure of the immune system competent in this process in IHD. Perhaps this is related to a special form of IHD.