Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the "smoker's paradox" from the GUSTO-I trial, with angiographic insights. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries.

OBJECTIVES: Our purpose was to evaluate the relation between smoking and the outcomes of patients receiving thrombolysis for acute myocardial infarction. BACKGROUND: A paradoxic beneficial effect has been observed in smokers with a myocardial infarction. We analyzed outcomes and baseline characteristics of 11,975 nonsmokers, 11,117 ex-smokers and 17,507 current smokers in a multinational trial of thrombolysis for acute myocardial infarction. METHODS: Patients were randomized to one of four thrombolytic protocols. An angiographic substudy in 2,431 patients evaluated reperfusion, reocclusion and ventricular function. Effects of smoking were evaluated by logistic regression analysis after adjustment for age and gender. A mortality model evaluated the simultaneous effect of baseline characteristics on the prognostic importance of smoking. These processes were performed with data from both the main trial and the angiographic substudy; then angiographic factors (coronary anatomy, patency and ejection fraction) were added to the model. RESULTS: Smokers were significantly younger by a mean of 11 years) and had less comorbidity or severe coronary artery disease than nonsmokers. Nonsmokers had significantly higher hospital and 30-day mortality rates (9.9% and 10.3%, respectively) than smokers (3.7% vs. 4%, respectively, both p < 0.001) and more in-hospital complications. The unadjusted odds ratio for 30-day mortality in nonsmokers was 3.36 (95% confidence interval [CI] 2.08 to 5.41), 1.21 (95% CI 0.71 to 2.08) after adjustment for age and gender and 1.08 (95% CI 0.59 to 1.96) after adjustment for all clinical baseline characteristics. CONCLUSIONS: Smokers receiving thrombolysis for acute myocardial infarction presented 11 years earlier than nonsmokers, which generally accounted for their better outcome. When other differences in clinical and angiographic baseline factors and therapeutic responses were evaluated, no significant difference in mortality was seen between smokers and nonsmokers.

Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.

OBJECTIVES: This study sought to examine the incidence, temporal profile and clinical implications of shock in a large trial of thrombolytic therapy for acute myocardial infarction. BACKGROUND: Despite advances in the treatment of acute ischemic syndromes, cardiogenic shock remains associated with significant morbidity and mortality. METHODS: Patients who presented within 6 h of symptom onset were randomized to four treatment strategies: 1) streptokinase plus subcutaneous heparin; 2) streptokinase plus intravenous heparin; 3) accelerated recombinant tissue-type plasminogen activator (rt-PA) plus intravenous heparin; or 4) streptokinase and rt-PA plus intravenous heparin. The primary end point was 30-day all-cause mortality. RESULTS: Shock occurred in 2,972 patients (7.2%): 315 (11%) had shock on arrival, and 2,657 (89%) developed shock after hospital admission. Reinfarction occurred in 11% of patients who developed shock compared with 3% of patients without shock. The mortality rate was significantly higher in patients who presented with (57%) or developed (55%) shock than in those without shock (3%) (p < 0.001). Shock developed significantly less frequently in patients receiving rt-PA. There were fewer deaths in patients who presented with shock and were treated with streptokinase plus intravenous heparin or who developed shock and were treated with streptokinase plus subcutaneous heparin. Patients who developed shock had a significantly lower 30-day mortality rate if angioplasty was performed. CONCLUSIONS: Because cardiogenic shock occurred most often after admission and with recurrent ischemia and reinfarction, recognizing signs of incipient shock may improve outcome. Fewer patients treated with rt-PA developed shock, yet those developing shock had the same high mortality rate as those presenting with shock, regardless of treatment. Only angioplasty was associated with a significantly lower mortality rate.

Decreased plasma dehydroepiandrosterone sulfate and dihydrotestosterone concentrations in young men after myocardial infarction.

Plasma levels of dehydroepiandrosterone sulfate (DHEA-S), testosterone, dihydrotestosterone (DHT) androstenedione, sex hormone-binding globulin (SHBG), lipoproteins, apolipoproteins and high density lipoprotein (HDL) subfraction were measured in 32 men aged 26-40 years after myocardial infarction (MI) suffered at least 3-4 months prior to the study, who were normocholesterolemic and had angiographically demonstrated coronary occlusion. The control group consisted of 76 healthy men aged 25-40 years. Blood samples were obtained in the morning from fasting subjects. A significant decrease in plasma DHEA-S and DHT levels were found in MI patients. Also, a significant decrease in HDL-cholesterol, HDL2-cholesterol (HDL2-C) and apolipoprotein A-I, an increase in apolipoprotein B and LDL-cholesterol (LDL-C) levels were observed in those patients as compared with healthy men. However, there were no differences in testosterone, androstenedione and SHBG concentrations between the groups. Significant correlations between testosterone and HDL2-C (r = 0.46, P less than 0.01), as well as between DHEA-S and HDL3-C (r = 0.39, P less than 0.05) levels in MI patients were observed. These results suggest that decreased levels of plasma DHEA-S and DHT may promote the development of coronary atherosclerosis in men.

Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men.

We investigated the effects of long-term testosterone replacement in hypogonadal and elderly men on lipids and lipoproteins. Twenty-two men with initial serum testosterone concentrations below 3.5 ng/ml took part in the study: 11 with hypopituitarism (1st group) and 11 otherwise healthy elderly men with low testosterone levels (2nd group). Testosterone deficiency was replaced by intramuscular injections of testosterone enanthate 200 mg every second week. Plasma levels of sex hormones, gonadotropins, SHBG, lipids and lipoproteins were determined before the treatment and after 3, 6 and 12 months of treatment. During the treatment serum testosterone and estradiol increased significantly, reaching normal levels. This was associated with a decrease in total cholesterol (from 225 +/- 16.9 mg/dl to 202 +/- 13.6 mg/dl after 6 months and 198 +/- 12.8 mg/dl after 1 year of testosterone administration, P < 0.0001 in men with hypoandrogenism associated with aging and from 255 +/- 12.1 mg/dl to 214 +/- 10.6 mg/dl after 6 months and 206 +/- 9 mg/dl after 1 year of treatment, P < 0.0001 in men with hypopituitarism) and LDL-cholesterol concentrations (from 139 +/- 12.5 mg/dl to 126 +/- 10.7 mg/dl after 6 months and 118 +/- 9.8 mg/dl after 1 year of testosterone administration, P < 0.0001 in men with hypoandrogenism associated with aging and from 178 +/- 10.3 mg/dl to 149 +/- 10.2 mg/dl after 6 months and 140 +/- 7.3 mg/dl after 1 year of treatment, P < 0.001 in men with hypopituitarism). However, no significant decrease in HDL-cholesterol levels or HDL2- and HDL3-cholesterol subfractions was observed. The effects of testosterone replacement therapy on lipids and lipoproteins were similar in both groups with different aetiology of hypogonadism. No side effects on the prostate were observed. The results of this study indicate that testosterone replacement therapy in hypogonadal and elderly men may have a beneficial effect on lipid metabolism through decreasing total cholesterol and atherogenic fraction of LDL-cholesterol without significant alterations in HDL-cholesterol levels or its subfractions HDL2-C and HDL3-C.

Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study.

OBJECTIVES: The revascularization procedures become more and more popular to treat coronary artery disease, in many countries. Some patients are free of angina after revascularization, without any documented re-stenosis present with recurrent angina symptoms after a period of time. The aim of this work was to assess the efficacy of trimetazidine in the subpopulation of patients with a history of PTCA or CABG, who were included in the TRIMPOL II study. METHODOLOGY: A subgroup of 94 patients was retrospectively analysed from the TRIMPOL II study, a multicentre, double-blind randomised placebo-controlled trial in 426 patients with stable effort angina. These patients have a history of revascularization for coronary artery disease, and they are still symptomatic after 6 months despite a treatment with metoprolol (50 mg twice daily). They were randomly allocated to receive either trimetazidine (20 mg 3 times daily) or placebo for 12 weeks, on top of the beta-blocker. Exercise test parameters, clinical efficacy and safety were assessed. Results were analysed using the Student test, the Mann-Whitney test or the Shapiro-Wilk test. RESULTS: Compared to placebo, the 12-week treatment with trimetazidine significantly improved: time to 1 mm ST segment depression (385.1 s +/- 144.6 s versus 465.0 s +/- 143.8 s [p < 0.01]); exercise test duration (466.9 s +/- 144.8 s versus 524.4 s +/- 131.5 s [p = 0.048]), total workload (9.0 m.e. +/- 2.4 m.e versus 10.1 m.e. +/- 2.4 m.e [p = 0.035]) as well as time to onset of angina (433.6 s +/- 164 s versus 508.1 s +/- 132.4 s [p = 0.031]). Weekly number of angina attacks and nitrate consumption were significantly reduced in the trimetazidine group when compared to placebo. Three mild gastro-intestinal side-effects were reported in the trimetazidine group. CONCLUSION: These results show that trimetazidine provides anti-anginal efficacy in post-revascularized patients with recurrent angina despite a monotherapy with metoprolol. The treatment was well accepted.

Advantages of exercise echocardiography in comparison to dobutamine echocardiography in the diagnosis of coronary artery disease in hypertensive subjects.

OBJECTIVE: The aim of the study was to compare the efficacy and safety of two stress echocardiography methods, exercise and dobutamine, in the diagnosis of coronary artery disease in hypertensive patients with angina. PATIENTS AND METHODS: A total of 197 treated hypertensive patients, age 53 +/- 9 years (65 women) with no history of myocardial infarction referred for coronary angiography were prospectively investigated with exercise electrocardiography (ECG), exercise and dobutamine echocardiography. RESULTS: Sensitivity of the exercise ECG, exercise echocardiography and dobutamine echocardiography did not differ (77%, 82% and 75%). Negative predictive value of exercise ECG was significantly lower than exercise echocardiography (64% vs 79%, P < 0.01). Specificity and positive predictive value of exercise ECG were markedly lower than exercise and dobutamine echocardiography (57%, 96%, 98% and 72%, 97%, 98%, P < 0.0001 for both stress echocardiography vs ECG). Specificity and sensitivity of diagnostic methods were not influenced by the presence of echocardiographic left ventricular hypertrophy. Dobutamine infusion in comparison to exercise was more often associated with substantial arterial blood pressure rise or fall (7% vs 2%, P < 0.05) and with simple ventricular ectopy (15,7% vs 6,1%, P < 0.05). CONCLUSIONS: In hypertensive patients with the symptoms of angina, both stress echo methods are significantly more specific than the exercise ECG test. Maximal exercise is associated with less frequent side effects than infusion of dobutamine, so exercise echocardiography may be preferred in the diagnosis of angina in hypertensive patients.

Resolution of an aortic mobile mass with anticoagulation without evidence of arterial embolism.

The prognostic significance of aortic mobile debris detected by transesophageal echocardiography (TEE) in patients without history of embolism has not been established. A mobile aortic arch mass was found by TEE in a 59-year-old man with coronary artery disease, and with rheumatic mitral valve disease, and with no embolic symptoms. The patient was anticoagulated for 6 weeks and the mass was no longer seen on repeated TEE. He had no embolic symptoms during 9 months of follow-up. Different therapeutic approaches to mobile aortic debris are discussed and anticoagulant treatment of asymptomatic cases is advocated.

[Prognostic value of QT-QS2 index in the assessment of sudden coronary death]. / Wartosc prognostyczna wskaznika QT-QS2 w ocenie wystepowania naglych zgonów w chorobie wiencowej.

200 patients aged 49 +/- 8 with coronary artery disease underwent selective coronarography, left ventriculography as well as performed every year laboratory, polycardiography, ECG exercise test, 24-hour ECG Holter monitoring and X-ray chest examinations. Mean follow-up period was 34 +/- 10 months. For QT-QS2 index monitoring patients were divided into two groups: I--with abnormal index QT greater than QS2 (61-30%) and II--with the normal one QT less than QS2 (139-70%). Lown's classification was applied for ventricular premature beats assessment. Left ventricular contractility was estimated in hemodynamic examination. 28 patients died due to cardiac reasons during follow-up (14%). Among 19 suddenly died patients (9.5%) 7 had a normal and 12 an abnormal QT-QS2 index. Sudden mortality rate was 5% in the normal QT less than or equal to QS2 subgroup, and 20% in the abnormal QT greater than QS2 one. These differences are statistically significant.

[Evaluation of the relative biological availability of amiodarone Polfa preparation after extravascular administration of a single dose]. / Ocena wzglednej dostepnosci biologicznej amiodaronu z preparatu amiodarone Polfa po jednorazowym podaniu pozanaczyniowym u ludzi.

Relative bioavailability of amiodarone was studied in 10 healthy volunteers after its 600 mg single dose administration. Mean values of individual maximal concentrations and time for reaching them did not significantly differ and were respectively 0.828 +/- 0.401 microgram/ml and 4.4 +/- 1.5 h for Amiodarone preparation Polfa and 0.541 +/- 0.207 microgram/ml and 5.2 +/- 1.6 h for Cordarone preparation. Bioavailability extent (EBA) of examined preparation was 120 per cent in comparison with the standard one. Amiodarone absorption from both preparations was slow and individually diversified. Absorption rate constant Ka did not statistically significant differ and was respectively 0.35 +/- 0.10 1/h and 0.49 +/- 0.35 1/h. Obtained data indicated that both preparations were biologically equivalent.

[Value of two-dimensional and Doppler echocardiography in the diagnosis of rupture of the interventricular septum in myocardial infarction]. / Wartosc echokardiograffii dwuwymiarowej i dopplerowskiej w diagnostyce chorych z peknieciem przegrody komorowej w przebiegu zawalu serca.

Usefulness of two-dimensional and Doppler echocardiography in diagnosis of the ruptured interventricular septum in a course of myocardial infarction was evaluated basing on own material consisted of 6 cases. Ventricular septal defect was visualized in 5 patients. The blood flow through the ventricular septum was detected in all of 6 patients. Obtained results were concordant with intraoperative and anatomicopathologic findings as for as the localization of the rupture is concerned.

[Comparative evaluation of biological availability and anti-arrhythmia effectiveness of Mexicard (mexiletine Polfa)]. / Ocena porównawcza biodostepnosci i skutecznosci antyarytmicznej Mexicordu (meksyletyny Polfa).

In 16 healthy males bioavailability of Mexicord (Polfa) was studied, in comparison with mexiletine of foreign made. Bioavailability extent (EBA) of Mexicord was over 99% in comparison with a standard drug. Comparative study of antiarrhythmic activity and side effects was performed in 32 patients with frequent ventricular premalure beats and nearly in a half of them resistant to antiarrhythmic agents. Mexicord was effective in 47% of treated patients, and side effects (most often nausea) were observed in 28% of patients, but only in 1 case therapy withdrawal was necessary. Statistical study proved a lack of significant differences in antiarrhythmic effectiveness and side effects between Mexicord (Polfa) and a drug of foreign made.

[Activitrax--a pacemaker with a regulated rhythm rate]. / Activitrax--stymulator z regulowana czestoscia rytmu.

In 10 patients: 7--with the complete atrioventricular block and 3 with the sick sinus syndrome the rate responsive activity sensing pacemaker--Activitrax was implanted. Significant increase of rheographically measured cardiac output in a course of rate responsive pacing in comparison with on demand constant frequency rate stimulation was stated during treadmill exercise tests performed 6 and 12 weeks after a pulse generator implantation.

[Treatment of 3 patients with arrhythmias using "radiofrequency" ablation]. / Leczenie 3 chorych z zaburzeniami rytmu serca metada "radiofrequency".

In 3 patients radiofrequency (RF) ablation of AV node (n = 2) and left sided accessory pathway (n = 1) was performed because of intractable tachyarrhythmias. RF ablation was made in the first patient (ablation of AV node) using 135 Watts during 72 sec., in the second patient (AV node ablation) 331 Watts during 185 sec., and in the last patient 883 Watts during 695 sec. In the last patient ablation of accessory pathway was unsuccessful and the patient has been successfully operated. AV conduction was interrupted in 2 cases. No complications were noted. General anesthesia was not required. All the patients were discharged in a good state.

[Sensitivity of exercise echocardiography, electrocardiographic exercise test and 24-hour ekg monitoring in diagnosing and evaluating the efficacy of coronary disease treatment]. / Znaczenie wysilkowej echokardiografii, elektrokardiograficznej proby wysilkowej i 24-godzinnego monitorowania EKG w rozpoznaniu i ocenie skutecznosci leczenia choroby wiencowej.

To test the sensitivity and specificity of noninvasive tests for detecting myocardial ischemia, 78 patients undergoing cardiac catheterisation for suspected coronary artery disease (CAD) were studied in prospective blinded manner with exercise echocardiography (EE), ecg stress test (ET) and 24-hour Holter monitoring for analysis of ST-segment changes (HM). All noninvasive tests were repeated after one year follow-up period. Exercise was performed in a supine position using a bicycle ergometer. Real time 2-DE examinations were performed in the left lateral position: at rest, at the peak of exercise and immediately after exercise testing. The sensitivity and specificity of EE, ET and HM for detection of CAD were: 76%, 92%; 90%, 48%; and 80%, 71% respectively. In a group of 48 pts with the narrowing of coronary artery (CA) < 50%, the follow-up EE was negative in 45. In a group of 30 pts with significant narrowing of CA, 10 were asymptomatic within one year after PTCA or CABG; in 9 of them the follow-up EE as well as ET were negative. HM less correlated with clinical course in asymptomatic subjects: in 4 patients it was negative and in 6 - positive. The reminding 20 patients with CAD treated medically, with PTCA or CABG were symptomatic after one year. The follow-up EE, ET and HM studies were positive in 17, 19 and 17 cases respectively. We conclude that sensitivity of EE in diagnosis of CAD is comparable to ET and HM, but its specificity is higher.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of coronary disease risk factors on the progression of coronary arteriosclerosis]. / Wplyw czynników ryzyka choroby wiencowej na progresje miazdzycy tetnic wiencowych.

UNLABELLED: A group of 43 patients (pts) from a larger group 451 pts with coronary artery disease (CAD) confirmed by coronary angiography were recatheterized because of deterioration of symptoms. After the first angiography patients had no indications to coronary artery bypass grafting (CABG) or gave no consent to surgery. The group comprised 3 women and 40 men aged 27 to 62 years (mean age 45 +/- 8 years). The mean interval between coronarography was 35 +/- 22 months. Four independent reviewers evaluated 15 segments of coronary arteries according to American Heart Association. The coronary lesions were scored on the basis of reduction in luminal diameter as follows: 0 point = 0-29%, 1 = 30-49%, 2 = 50-69%, 3 = 70-98%, 4 = 90-99%, 5 = 100% occlusion. The influence of the following risk factors on the progression was evaluated: age, sex, hypertension, diabetes, lipid disturbances, smoking, hyperuricaemia, family history. The patients were divided into 3 groups: group I--no or slight progression (0 to 4 points) in two successive coronary angiographies, group II--moderate progression (5 to 9 points) and group II--significant progression (10 points or more). The number of patients in these groups was 14, 12 and 17 respectively. In such isolated groups, the clinical events were compared: unstable angina, myocardial infarctions, need for CABG, cardiac deaths within follow-up period. The ejection fraction of the left ventricle was also evaluated. STATISTICAL ANALYSIS: was conducted by multiple regression model.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thrombolytic therapy of myocardial infarction. Prognostic value of early reduction of elevation of ST segment]. / Zawal serca leczony trombolitycznie. Znaczenie rokownicze wczesnej redukcji uniesienia odcinka ST.

In-hospital mortality, infarction mass (estimated enzymatically) and electrocardiographic indexes (total ST-segments elevation, number of leads with R-wave presence and total R-waves amplitude) were assessed in 532 patients with acute myocardial infarction, randomized to two treatment groups: 272 treated with streptokinase (SK) and 260 with heparin (H). Echocardiographic contractility indexes (contractility disturbances area index, contractility disturbances index, left ventricle diastolic diameter) and heart volume estimated from X-ray film were also assessed. There were no significant differences in mortality and infarction area between the two groups. In 175 patients total ST-segments elevation was reduced by at least 50%, in the rest 340 patients this reduction was less significant. In the group with early elevated ST-segment reduction there were less in-hospital deaths (p less than 0.01), smaller infarction mass (p less than 0.0001) and significantly less disturbed electrocardiographic contractility indexes. Results suggest that simple electrocardiographic index, namely reduction of ST-segment elevation by 50% after 2 hours of treatment may be a useful prognostic tool, independent on treatment options, as far as in-hospital mortality, necrosis mass and left ventricle contractility disturbances are concerned.

[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)

[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)