Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis.

AIMS: The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. METHODS AND RESULTS: We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m², 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥ 55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥ 40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. CONCLUSION: Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.

Clinical assessment of the efficacy of SpineCor brace in the correction of postural deformities in the course of idiopathic scoliosis.

BACKGROUND: The objective of the study was to perform a clinical, comparative assessment of the degree of postural deformities before and after the treatment of idiopathic scoliosis in patients treated with SpineCor brace compared to the control group. MATERIAL AND METHODS: A group of 90 children with idiopathic scoliosis (including 74 girls) at the average age of 12.2 was subject to prospective observation. Average pre-treatment Cobb angle was 24.9° in the thoracic spine and 25.8° in the lumbar spine. The group actively treated with the SpineCor brace consisted of 45 children, while the control group consisted of the remaining 45 children with the natural course of the disease. RESULTS: Both groups did not differ significantly in terms of age, gender, height, body weight, Risser sign of skeletal maturity and baseline clinical and radiological parameters of scoliosis. Significant reduction of rib hump was observed upon 2-year SpineCor brace treatment (P=0.04) compared to the group treated by physiotherapy only (P=0.91). Similarly, improvement in lumbar prominence was observed in the actively treated group (P=0.009), with a trend towards worse results in the control group (P=0.07) In the group treated with the SpineCor brace, significant reduction in pectoral and hamstring muscle contractures as well as reduction in shoulder asymmetry and reduction in anterior and posterior vertical deviation were observed. CONCLUSIONS: Treatment using the SpineCor dynamic brace leads to a clinical improvement in posture, particularly to reduction in rib hump, lumbar prominence and muscular contractures.

Evaluation of selected risk factors for cardiovascular diseases and diabetes as a background for the prevention program in occupational healthcare.

OBJECTIVES: Cardiovascular and metabolic disorders constitute major health problems in the working populations in Europe. The aim of this project was to evaluate the health condition of workers employed in a Polish research and medical institution, and then to establish the necessary preventive actions by creating a modern model of occupational healthcare integrated with civilization disease (CivD) prevention. MATERIAL AND METHODS: Overall, 100 workers voluntarily participated in a health program for CivD prevention during mandatory prophylactic examinations. Data from these examinations was collected in a system of electronic documentation to enable the analysis of the workers' health condition and risk factors of CivDs. RESULTS: Women accounted for 72% of the employees who voluntarily participated in the prevention program, and 80% of the subjects had university education. As regards the health condition, 27% of the patients had elevated systolic, and 23% diastolic, blood pressure, and 21% had an abnormal fasting glucose level. Stressful job was an important factor correlated with an excessive body mass index, diastolic blood pressure, as well as total and low-density lipoprotein cholesterol levels. Smoking, sedentary work and a lack of physical activity were significant factors for abdominal obesity. Generally, 94% of the program participants required some further interventions in lifestyle, diagnostics or treatment. CONCLUSIONS: Civilization disease prevention should focus on increasing physical activity both in leisure time and at the workplace as far as practicable. There is a need for implementing projects leading to occupational stress reduction and smoking cessation. Men as well as workers with vocational and elementary education need to be recruited for prevention programs dedicated to employees. Int J Occup Med Environ Health. 2021;34(3):403-13.

A head-to-head comparison of wall motion score index, force, strain, and ejection fraction for the prediction of SYNTAX and Gensini coronary scores by dobutamine stress echocardiography.

BACKGROUND: Predicting the severity of coronary artery disease (CAD) may be possible during dobutamine stress echocardiography (DSE) with various indices of left ventricular function. AIMS: We assessed the relative value of ejection fraction (EF), force, global longitudinal strain (GLS), and wall motion score index (WMSI) in predicting SYNTAX and Gensini scores in patients with known or suspected CAD. METHODS: We prospectively enrolled 223 patients (120 men; mean [SD] age, 62 [9] years) and assessed the following indices: 1) EF (with triplane imaging); 2) force, calculated as the ratio of systolic blood pressure to left ventricular end­systolic volume; 3) GLS; 4) WMSI. All patients underwent coronary angiography within 12 weeks with SYNTAX and Gensini scores evaluation. RESULTS: The correlation of SYNTAX and Gensini scores was highest with peak WMSI (SYNTAX, rho = 0.591; Gensini, rho = 0.612; P <0.001), intermediate with peak force (SYNTAX, rho = -0.346; Gensini, rho = -0.377; P <0.001) and GLS (SYNTAX, rho = -0.205; P = 0.002 and Gensini rho = -0.216; P = 0.001), and the weakest for EF (SYNTAX, rho = -0.149; P = 0.03 and Gensini, rho = -0.191; P = 0.006). The similar hierarchy of variables was detected for changes during DSE. In the subgroup after myocardial infarction (n = 66 [27%]), GLS outperformed the force. CONCLUSIONS: In patients with CAD at DSE peak, theWMSI and force were better predictors of the coronary SYNTAX and Gensini scores and CAD severity than GLS or EF. However, in patients after myocardial infarction, the GLS correlation with coronary scores improved and got closer to the visual assessment.

Impact of intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction on left ventricular perfusion and function: a 6-month follow-up gated 99mTc-MIBI single-photon emission computed tomography study.

PURPOSE: We investigated the impact of intracoronary injection of autologous mononuclear bone marrow cells (BMC) in patients with acute ST elevation myocardial infarction (STEMI) on left ventricular volumes, global and regional systolic function and myocardial perfusion. METHODS: The study included 39 patients with first anterior STEMI treated successfully with primary percutaneous coronary intervention. They were randomly assigned to the treatment group or the control group in a 2:1 ratio. The patients underwent baseline gated single-photon emission computed tomography (G-SPECT) 3-10 days after STEMI with quantitative and qualitative analysis of left ventricular perfusion and systolic function. On the following day, patients from the BMC treatment group were subjected to bone marrow aspiration, mononuclear BMC isolation and intracoronary injection. No placebo procedure was performed in the control group. G-SPECT was repeated 6 months after STEMI. RESULTS: Baseline and follow-up G-SPECT studies were available for 36 patients. At 6 months in the BMC group we observed a significantly enhanced improvement in the mean extent of the perfusion defect, the left ventricular perfusion score index, the infarct area perfusion score and the infarct area wall motion score index compared to the control group (p = 0.01-0.04). However, the changes in left ventricular volume, ejection fraction and the left ventricular wall motion score index as well as the relative changes in the infarct area wall motion score index did not differ significantly between the groups. CONCLUSION: Intracoronary injection of autologous mononuclear BMC in patients with STEMI improves myocardial perfusion at 6 months. The benefit in infarct area systolic function is less pronounced and there is no apparent improvement of global left ventricular systolic function.

Early prediction of ventricular recovery in Takotsubo syndrome using stress and contrast echocardiography.

BACKGROUND: Takotsubo syndrome is a primary, stress-provoked acquired cardiomyopathy mimicking acute myocardial infarction. Because of the less severe prognosis of takotsubo patients, a reliable method of predicting complete functional recovery has great practical value. CASE REPORT: A case of takotsubo syndrome is reported in a 59-year-old Caucasian woman in whom early echocardiographic imaging demonstrated normal myocardial perfusion and contractile reserve predictive of complete functional recovery. The patient was admitted with symptoms of acute coronary syndrome triggered by severe stress. Coronary angiography revealed no stenosis, whereas echocardiography revealed wall motion abnormalities of the left ventricular apex with an ejection fraction of 30%. Using low-dose dobutamine stress echocardiography and myocardial contrast echocardiography, the preliminary diagnosis of takotsubo cardiomyopathy was confirmed and a good prognosis regarding the recovery of wall motion abnormalities was predicted. After 30 days, echocardiography revealed fully restored ventricular function and a 270-day follow-up was uneventful. CONCLUSIONS: Microcirculation assessment using myocardial contrast echocardiography as well as early contractile reserve in a low-dose dobutamine echocardiographic test might be useful in the prediction of functional recovery in suspected takotsubo syndrome.

M-mode speckle tracking--a novel echocardiographic approach to assess left ventricular torsional deformation.

BACKGROUND: Speckle tracking echocardiography (STE) requires special image processing for complex assessment of left ventricular (LV) function, including strain and rotation. AIM: To evaluate a novel M-mode STE technique as a readily applicable approach, providing potential insights into LV deformation. METHODS: Fifty one patients (mean age 52 +/- 14 years, 24 women) with normal or impaired LV function (mean LVEF 51 +/- 16%, range between 14% and 66%) were studied. Left ventricular rotation at mitral valve and apical level was measured using dedicated conventional STE software. Grey-scale short axis digital loops at mitral valve level were also used to obtain M-mode STE images, presenting the movement of LV wall speckles along the cursor, with the LV cavity left out. Then, the distance of peak systolic shift (PSS) was measured for one selected speckle. RESULTS: Mean rotation at mitral valve level was 7.4 +/- 3.1 degrees , apical rotation was 7.6 +/- 6.4 degrees and LV torsion was 14.9 +/- 7.1 degrees . Measurement of PSS with a novel M-mode STE approach was feasible in all patients, producing a mean value of 7 +/- 2 mm. Subsequently, two subsets with PSS of less than 7 mm and PSS equal to or above 7 mm showed a significant difference between mean LV torsion of 10.7 degrees and 17.0 degrees , respectively (p = 0.002). In the ROC analysis, PSS cut-off value of less than or equal to 7 mm yielded a sensitivity of 92% and a specificity of 61% to predict LV torsion < 10.7 degrees (p < 0.0001). CONCLUSIONS: M-mode STE appears to be a feasible approach to detect movement of speckles and to measure PSS within the LV inferior and septal wall in short axis view images. PSS cut-off value of less than 7 mm indicates significantly lower LV torsion. Further studies are required to assess the potential role of M-mode STE in cardiac imaging.

Intracoronary administration of stem cells in patients with acute myocardial infarction - angiographic follow-up.

BACKGROUND: Even up-to-date reperfusion therapy using primary percutaneous intervention (PCI) in acute myocardial infarction does not result in improvement of the left ventricular (LV) function in all patients. Cellular myoblasty, a novel method using mononuclear bone marrow cells (BMC), can be applied in the infarcted myocardium area to stimulate regeneration and to limit the organ damage. However, the impact of intracoronary BMC administration on the effect of PCI is not clear. AIM: To assess angiographic outcomes in patients with anterior myocardial infarction and LV dysfunction, undergoing intracoronary BMC administration after a successful primary PCI. METHODS: The study group consisted of 40 patients (mean age 56.2 years) with LV ejection fraction below 40%, in whom 20 ml of BMC were administered to the infarct-related artery (IRA) distally to the occlusion. The control group comprised 25 age- and sex-matched patients with similar values of LV ejection fraction undergoing bare metal stenting of IRA without BMC administration. Quantitative coronary angiography was performed 6 months later to assess IRA patency. RESULTS: The reference diameter of the stented artery decreased in the study group from 3.22 +/- 0.28 mm to 3.16 +/- 0.18 mm (p < 0.05) and in the control group from 3.22 +/- 0.31 mm to 3.15 +/- 0.28 mm (p < 0.082); also in the area of the implanted stent the diameter decreased from 3.57 +/- 0.21 mm to 2.96 +/- 0.79 mm in the study group vs. 3.48 +/- 0.22 mm to 3.01 +/- 0.35 mm in the control group. For lumen diameter measured 10 mm distally to the stent, the diameter loss was similar in both groups. In 6 patients from the BMC treated group and in 3 patients from the control group there was asymptomatic lumen reduction > 70% (NS). CONCLUSION: The results of our study show that BMC administration into IRA is safe. The degree of lumen loss in the stent area was larger in the BMC group than in the control group. There was no significant difference in the lumen change distally to the stent; the artery diameter loss in both groups was similar, and the improvement in LV ejection fraction was greater in the BMC-treated group.

The effects of intracoronary autologous mononuclear bone marrow cell transplantation on cardiac arrhythmia and heart rate variability.

BACKGROUND: The results of stem cell therapy after myocardial infarction (MI) have been conflicting. The effects of this therapy on ventricular arrhythmias and autonomic control of heart rate have not yet been established. AIM: To assess the effects of bone marrow cell (BMC) transplantation on the occurrence of arrhythmias and heart rate variability (HRV) parameters in short-term observation after ST-elevation myocardial infarction (STEMI). METHODS: Sixty patients with STEMI who underwent primary PCI, were randomly assigned to two groups: Group 1 - 36 patients selected for active treatment (autologous BMC, intracoronary injection mean 7 days after STEMI), and Group 2 - 24 control patients not treated with BMC transplantation. In all patients the infarct-related artery was the left anterior descending, and the left ventricular ejection fraction was < 40%. Two Holter sessions were performed: at baseline (HM1), on average 6 days after MI, and another one (HM2), 1 month after BMC implantation. From these recordings the frequency of non-sustained ventricular tachycardia (nsVT) episodes and the parameters of HRV were calculated. RESULTS: Both groups were comparable with regard to demographic data, the presence of risk factors and electrocardiographic parameters. In HM2 examination the frequency of nsVT tended to be higher in Group 1 (25 vs. 12.5%, NS). The HRV analysis showed lower HF and significant SDNN increase in the BMC group. In controls all the HRV parameters increased. The increase in HF was significantly lower in the BMC group than in controls (22.4 vs. 89.2 ms(2), p $lt 0.011). CONCLUSIONS: 1. During the first month after the intracoronary injection of BMC, non-significant increase of nsVT was observed. 2. The lack of significant increase in HF power after BMC infusion may be a sign of depressed parasympathetic tone.

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program.

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established. OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment. MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients' suitability for RDN. RESULTS: A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), ß-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), ß-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). CONCLUSIONS: Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients.

The relationship between left ventricular late-systolic rotation and twist, and classic parameters of ventricular function and geometry.

BACKGROUND: Using speckle tracking echocardiography we investigated left ventricular (LV) twist and rotation (ROT) at the papillary muscle (PM) level and their correlation with standard echocardiographic and demographic parameters. AIM: To assess whether the fulcrum of LV short axis ROT is shifted in myocardial disease. METHODS: The study group consisted of 33 patients (54+/-13 years old, 18 women). Left ventricular systolic function was normal in 6, and various degrees of wall motion abnormalities were present in the others [LV ejection fraction (LVEF) 49+/-15, wall motion score index (WMSI) 1.43+/-0.38]. Short axis images at basal, PM and apical level were analysed offline. The direction of ROT was determined from the apical aspect and expressed in degrees: clockwise (CW) in negative values, counter CW in positive. Twist is the arithmetic difference between apical and basal ROT. RESULTS: Left ventricular twist was in the range of 0.4-27.5 (14+/-7) degrees and correlated with LV systolic diameter (LVS), r=-0.46, 95% CI from -0.69 to -0.13, p <0.01; LV diastolic diameter (LVD), r=-0.40, 95% CI from -0.65 to -0.06, p=0.02; and systolic motion score index of 6 mid segments (6S-MSI), calculated as WMSI at PM level, r=-0.37, 95% CI from -0.63 to -0.03, p <0.04. Linear regression resulted in a model including interventricular septum systolic thickness (IVSS) and 6S-MSI, which predicted twist correctly in 21% of cases. Twist was independent of LVEF and overall WMSI. The PM ROT value correlated with: apical ROT, r=0.36, 95% CI 0.02-0.63, p <0,04; posterior wall systolic thickness (PWS), r=0.39, 95% CI 0.05-0.64, p <0.03. We distinguished Group A, n=14, with CW direction of PM ROT - negative values, range from -5.2 to -0.9; Group B, n=19, with counter CW, range 0.4-4.9. Apical ROT was 5 vs. 10 degrees, p <0.03; PWS 14 vs. 15 mm, p <0.03; diastolic posterior wall thickness 10 vs. 12 mm, p <0.04, respectively. In univariate logistic regression, we identified independent factors related to counter CW PM ROT: apical ROT (OR=1.15, 95% CI 1.00-1.33, p <0.05) and PWS (OR=1.71, 95% CI 1.03-2.84, p <0.04). Multiple logistic regression resulted in a model predicting counterCW rotation at PM (p <0.01) including: apical ROT (OR=1.18, 95% CI 1.00-1.38, p <0.05) and PWS (OR=1.77, 95% CI 1.02-3.08, p <0.05). ROC curves identified cut-off values of apical ROT >11.3 deg and PWS >13 mm. We found counterCW PM ROT in all patients with both conditions, 59% of patients with one, 22% with none. CONCLUSIONS: Left ventricular twist is related to mid segments function and IVSS, while PM ROT value and its direction (associated with 'zero ROT level') is related to PWS and apical ROT, rather than to LVEF or WMSI. Thus twist and rotation may reflect novel aspects of LV function.

Conscious sedation for transcatheter implantation of atrial septal occluders with two- and three-dimensional transoesophageal echocardiography guidance - a feasibility and safety study.

BACKGROUND: General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. AIM: We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. METHODS: A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 µg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. RESULTS: Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce-dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 µg/kg) and fentanyl was 30.0 ± 11.9 µg (0.43 ± 0.17 µg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. CONCLUSIONS: Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.

Is it possible to improve compliance in hypertension and reduce therapeutic inertia of physicians by mandatory periodic examinations of workers?

BACKGROUND: Due to high prevalence, insufficient recognition, and ineffective treatment, hypertension (HT) still remains a major medical and socio-economic problem. There is a real necessity to develop effective prophylaxis for cardiovascular disorders (CVD), based on strategies that support compliance during long-term therapy. The Polish scheme of occupational health services with mandatory periodical employee check-ups creates a unique opportunity for effective HT prophylaxis. As a result, visiting a doctor is required not only due to health ailments but also by law, which is especially important for those feeling well. It enables an improvement in tertiary prevention, including actions taken not only by the doctors of the occupa-tional health services, but also by the physicians in charge of treating the patients. AIM: Evaluation of the usefulness of mandatory health check-ups of employees concerning frequency of diagnosis and im-provement of treatment outcomes of HT. METHODS: The study group comprised 1010 Polish workers referred by their employers for mandatory medical examinations. All of the study participants filled in a questionnaire focused on self-assessment of their health, current blood pressure (BP) mea-surements, and in cases where HT had been previously detected - compliance with medical recommendations. Then in the doctor's office BP measurements were taken twice. Workers who fulfilled a criterion indicating a need for intervention were educated on optimal diet, physical activity, and risk factors for CVD. They also received medical instructions for three-step action. The first recommendation: measure BP three times a day for one week and record the results. The second: visit a gen-eral practitioner (GP) for a professional assessment of those results. The third: re-visit the occupational health physician within three months. The criterion for intervention was prior HT and a mean of two BP measurements ≥ 180/110 mmHg - in each case, or ≥ 140/90 mmHg - in the case of occupational exposure to risk factors for CVD. RESULTS: The mean age of the study participants was 41.7 years (similar in both genders). A previous diagnosis of HT was declared by 20.1% of patients. 11% of patients involved in the intervention did not comply with medical advice. The current HT therapy of all of the subjects with HT (100% of those with abnormal BP, who visited their GP) was modified. CONCLUSIONS: Prophylactic medical check-ups of workers gives improved compliance and medical surveillance of HT in patients with an uncontrolled clinical course of this disease. Obligations and periodic examinations encourage both patients and physicians to improve compliance and reduce the risk of therapeutic inertia.

Nitroglycerin infusion after percutaneous coronary intervention does not influence short- and long-term outcome--a prospective NAPI (Nitroglycerin Administration after Percutaneous Intervention) study.

BACKGROUND: Although the benefit of nitroglycerin infusion in patients after elective coronary angioplasty has not been established, this regimen is routinely used in some centres. AIM: The Nitroglycerin Administration after Percutaneous Intervention (NAPI) study tested the efficacy of routine nitroglycerin infusion on the 1st day after percutaneous coronary intervention (PCI) in a double-blind randomised single-centre clinical trial. METHODS: We randomly assigned 200 patients scheduled for elective PCI to treatment with nitroglycerin (100 patients, age 58+/-6 years, infusion up to 100 microg/min) or placebo (100 patients, age 57+/-5 years, p=NS, NaCl 0.9%) for 12 hours after PCI. Patients with acute myocardial infarction, haemodynamic instability during PCI and known intolerance to nitrates were excluded. Patients who were randomised to the placebo group had the possibility to receive nitroglycerin infusion according to the attending physician's decision. Clinical endpoints (cardiac death, myocardial infarction, postprocedural chest pain, unstable angina and repeated PCI) were assessed in hospital and out of hospital with follow-up extended to 24 months. RESULTS: There were no differences during in-hospital stay between those receiving nitroglycerin and receiving placebo, regarding mortality (0 vs. 0%, NS), myocardial infarction (0 vs. 2%, NS), postprocedural chest pain (10 vs. 8%, NS) or repeated PCI (0 vs. 2%, NS). Similarly, 24-month follow-up also revealed no significant differences between those receiving nitroglycerin and placebo (mortality: 0 vs. 0%, NS; myocardial infarction: 4 vs. 4%, NS; repeated PCI: 10 vs. 8%, NS or CABG: 0 vs. 0%, NS). CONCLUSIONS: Routine use of intravenous nitroglycerin after elective PCI has no influence on in-hospital and long-term outcome, including cardiac death, myocardial infarction, postprocedural chest pain, unstable angina and repeated PCI.

Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty.

BACKGROUND: The ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction (STEMI) have recommended primary PCI (pPCI) as the preferred reperfusion therapy, when it can be performed in a timely fashion, within 90-110 min from the first contact with medical personnel. The impact of treatment delays on outcomes in patients undergoing pPCI has been controversial. AIM: To evaluate the impact of time delays on in-hospital mortality and on the frequency of cardiac events during 30 days after STEMI. METHODS: 1723 patients were stratified on the basis of their time delays: from symptom onset until balloon inflation. The patients were divided into 4 groups: group 1 (311 patients) - time from symptom onset <90 min; group 2 (731 patients) - time delays of 90-180 min; group 3 (535 patients) - time delays of 180-360 min, and group 4 (146 patients) - time from symptom onset >360 min. RESULTS: The median time delay was 268.5+/-206 min, the median door to balloon time was 36.12+/-11.2 min. The patients with longer time delays (group 4) were older, more often were women, and had a higher frequency of diabetes, anterior MI and Killip class 4. During hospitalisation, 70 (4.1%) patients died. In-hospital mortality was significantly higher in group 4 (13.6%) than in other groups. Complications of STEMI such as cardiogenic shock considerably influenced mortality (45.6%). During a 30-day follow- -up, the patients with cardiogenic shock and the elderly had an increased risk of cardiac events. Also, time delays >360 min and failed pPTCA were independent adverse risk factors in multivariate regression analysis. CONCLUSION: Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.

Laser biostimulation in end-stage multivessel coronary artery disease--a preliminary observational study.

BACKGROUND: Low-energy laser radiation through its direct influence on tissue repair processes without heating effect may have vital importance in the therapy of patients with advanced coronary artery disease (CAD). AIM: The introductory assessment of the effects of laser biostimulation applied to patients with advanced multivessel CAD. METHODS: 39 patients with advanced CAD were assigned (mean age 64.8+/-9.6, male gender 64%, CCS class 2.5+/-0.5, EF=46+/-11%, 69% with a history of acute myocardial infarction), to undergo two sessions of irradiation of low-energy laser light on skin in the chest area from helium-neon B1 lasers. The time of irradiation was 15 minutes while operations were performed 6 days a week for one month. Before including the patients in the experimental group a full clinical evaluation, basic biochemical tests, ECG, 24h Holter recordings, 6-minute walk test, treadmill test using Bruce protocol and full echocardiographic examination were performed. After the first and second period of laser therapy with a one-month break between them analogical parameters with the initial examination were measured. RESULTS: No side effects associated with the laser biostimulation or performed clinical tests were noted. Lower CCS class (2.5+/-0.5 --> 2.2+/-0.4 --> 2.0+/-0.4, p<0.001), higher exercise capacity (5.1+/-2.2 --> 5.8+/-2.2 --> 6.6+/-2.5 [METS], p=0.023), longer exercise time (257+/-126 --> 286+/-127 --> 325+/-156 [s], p=0.06), less frequent angina symptoms during the treadmill test (65% --> 44% --> 38%, p=0.02), longer distance of 6-minute walk test (341+/-93 --> 405+/-113 --> 450+/-109 [m], p <0.001), lower systolic blood pressure values (SP 130+/-14 --> 125+/-12 --> 124+/-14 [mmHg], p=0.05) and trend towards less frequent 1 mm ST depression lasting 1 min during Holter recordings were noted. CONCLUSIONS: An improvement of functional capacity and less frequent angina symptoms during exercise tests without a significant change in the left ventricular function were observed. Laser biostimulation in short-term observation was a very safe method. These encouraging results should be confirmed in a larger, placebo-controlled study.

Variability of longitudinal strain in left ventricular segments supplied by non-stenosed coronary artery: insights from speckle tracking analysis of dobutamine stress echocardiograms in patients with high coronary risk profile.

INTRODUCTION: Although global deformation parameters have been increasingly used for myocardial function analysis, there are sparse data concerning segmental deformation of the left ventricle (LV). Moreover, some studies suggest heterogeneity of strain among LV segments, which may be especially significant during stress echocardiography. We assessed quantitatively regional LV function in the setting of dobutamine stress echocardiography (DSE), to examine differences of longitudinal strain between basal, mid and apical LV segments and to compare variability of regional deformation between rest and the peak stage of DSE. MATERIAL AND METHODS: Among 250 patients examined by DSE applied for diagnosis of ischemia, a subset of 111 patients without significant coronary stenoses in angiography was selected (68 females, mean age: 60 ±10 years). Systolic longitudinal strain (SLS) in individual LV segments at baseline and the peak stage of DSE was analyzed with speckle tracking echocardiography. RESULTS: Inhomogeneity of SLS among the LV segments (p < 0.001) was observed at baseline and the peak stage. Dispersion indices were higher at the peak stage of DSE than at baseline (p < 0.001), and the lowest heterogeneity was observed among mid segments. The analysis of changes in SLS during DSE showed SLS reduction in basal and mid-ventricular segments and an increase in apical segments. CONCLUSIONS: Significant heterogeneity of strain and the opposite direction of the longitudinal strain changes during DSE between apical and basal LV segments were observed. This variability among non-ischemic LV segments ought to be considered in quantification of LV function during DSE.