Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis.

An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.

Left ventricular geometry and function in patients with aortic stenosis: gender differences.

BACKGROUND: Gender differences in cardiac size have been described in normal and pathological conditions in human and animals. Sex determination of a pattern of hypertrophy as a response to pressure overload has not been extensively evaluated and is still poorly understood in humans. METHODS AND RESULTS: To investigate the influence of gender in the left ventricle remodelling and preservation of the left ventricle function 195 adults (140 men and 55 women) with isolated aortic stenosis were evaluated. The mean age was 52 +/- 11 years for men and 53 +/- 13 years for women. All the patients had similar degree of aortic stenosis finally treated with valve replacement, similar clinical status and no signs of coronary artery disease in coronary angiograms. On echocardiography the left ventricle of women had a smaller the end systolic (30.5 +/- 7.8 vs. 39.4 +/- 11.2, P<0.001) and the end diastolic (49.4 +/- 9 vs. 57.3 +/- 11, P<0.001) chamber size. The female left ventricle generated a higher relative wall thickness (0.65 +/- 0.21 vs. 0.52 +/- 0.12, P<0.01), a greater fractional shortening (35.3 +/- 8.5 vs. 32.0 +/- 9.0, P<0.01) and a higher ejection fraction (64.4 +/- 12.7 vs. 57.5 +/- 14.6, P<0.001). The left ventricle posterior wall thickness and the septal thickness indexes were similar in both groups. There were also significant differences between the two groups in the left ventricle mass index. CONCLUSIONS: Gender has an important influence on the left ventricle adaptation pattern to pressure overload due to aortic stenosis. Women developed a greater degree of left ventricle hypertrophy documented as changes in left ventricle geometry (increased relative wall thickness, left ventricular mass) and left ventricle function (fractional shortening and ejection fraction).

Thallium-201 myocardial perfusion imaging in patients before and after successful percutaneous transluminal coronary angioplasty.

We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial perfusion improvement and the detection of restenosis in patients after successful percutaneous transluminal coronary angioplasty (PTCA). Fifty-three patients (43 male and 10 female) ages 38-71 years (mean 55.3) were analysed. Exercise Tl-201 scintigraphy was performed before PTCA, and 6-10 days and then 3-6 months after the procedure. In all patients repeated coronary angiography was done 3-6 months after PTCA. Before PTCA myocardial perfusion defects were observed in all patients. Immediately after PTCA, an improvement in myocardial perfusion was noted in 36 patients (61%). Total normalisation of the scintigraphic picture was observed in only 12 patients. Coronary angiography after 3-6 months showed patency of dilated vessels in 11 out of those 12 patients (91.3%). In scintigraphy, performed 3-6 months after PTCA, a normal scan was present in 20 patients and recurrence of stenosis was found in only 2 of those 20. Stenosis was found in 22 (60%) of 33 patients with perfusion defects. For the purpose of describing the character of the myocardial perfusion changes, statistical analysis of a number of segments was performed. The predictive value of Tl-201 scintigraphy for detection of restenosis was established. The positive value for the procedure performed 6-10 days after PTCA was 56%, and the negative value of prediction of restenosis was 91%. Three to 6 months after PTCA, a high negative value of scintigraphy was observed (-90%) and a low positive predictive value was still present (63%).

Long-term outcome in patients with unstable angina treated by coronary balloon angioplasty.

UNLABELLED: Comparison of balloon angioplasty results in 472 patients with stable angina (SA) and 158 patients with unstable angina (UA) in 5-year follow-up is reported. Clinical success rate did not differ significantly, while periprocedural complications rate was higher in UA group (22.3 vs. 11.1%, P<0.001). During follow-up UA patients demonstrated higher: restenosis rate (48.5 vs. 30.4%, P<0.001), incidence of myocardial infarction (8.8 vs. 3.0%, P=0.004), although cardiac mortality did not differ significantly (2.2 vs. 1.6%). Reintervention rate in patients with unstable angina resultant from restenosis or significant artherosclerosis progression in coronary vessels, or originating from both of them, was also higher (53.7 vs. 34.1%, P<0.001). Event-free survival was significantly lower in UA patients (43.4 vs. 61.3%, P=0.02). The uni- and multivariate analysis proved that unstable angina was an independent risk factor in restenosis, re-intervention and cardiac events rate, despite perceptible differences in the baseline characteristics. Sub-group analysis of UA patients according to Braunwald classification revealed lower success rate and higher incidence of myocardial infarction during follow-up in post-infarction angina (class C), whereas new onset, no-rest angina (class I) had higher event-free survival in comparison with rest angina (classes II and III). CONCLUSIONS: UA patients treated by balloon angioplasty had higher periprocedural complications rate, as well as restenosis and re-intervention rate. Despite higher cardiovascular events rate during 5-year follow-up in UA group, survival rate in both groups was high and cardiac mortality did not differ significantly. Unstable angina constitutes a strong independent risk factor in adverse long-term outcome.

Long-term outcome of coronary balloon angioplasty in diabetic patients.

Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.

Clinical and echocardiographical study of the aortic homograft implantations in patients with Marfan syndrome.

The aim of the study was to assess the long-term results of surgical treatment with homogenic aortic grafts (HAGs) implantation in patients with Marfan syndrome. There were 31 patients with Marfan syndrome and aortic aneurysm who were operated on between 1980 and 1996. Aortic dissection was diagnosed in 14 patients, DeBakey Type I in six patients and Type II in eight patients. Four patients had to be operated urgently in cardiogenic shock with cardiac tamponade. Sealing up and reinforcement with strip of felt or Gore-Tex has been applied in 22 patients. The surgical modifications mentioned above have been applied since 1987 in all patients with the diameter of the aortic ring exceeding 30 mm or with active infective endocarditis or during reoperation. In 16 patients the space between the aortic homograft and patients own aortic wall was joined to the right atrial auricle. Patients were followed up for 12-179 months (average: 94.6 +/- 499). Three patients died in the early postoperative period and four patients died in the late postoperative period. Rethoracotomy because of bleeding complications was necessary in five patients. HAG damage was responsible for six other reoperations-new HAGs have been implanted in three patients and artificial prostheses were implanted in the other three patients. In the late follow-up period significant improvement in cardiac performance was observed in 24 patients (NYHA I or II). Survival probability of 15 years for the whole group was 80%. The lowest survival probability has been shown in the group of patients with DeBakey Type I aortic dissection (35% survived 15 years after operation). Echocardiographic follow-up has shown that the pressure gradient in HAG was low (7.4 +/- 6.2 mmHg). Only in two patients did the HAG gradient exceeded 20 mmHg. There were no significant differences concerning aortic ring diameters, dimensions of HAG and echocardiographic parameters between the group with surgical modifications, i.e. sealing up and reinforcement with strip of felt or Gore-Tex applied and the group in which these modifications were not applied. Homogenic aortic graft implantation as a method of surgical treatment of aortic aneurysm in patients with Marfan syndrome avoids postoperative anticoagulation, results in substantial improvement of cardiac performance and prolongs life. Surgical treatment should be considered in asymptomatic patients with large aneurysms (exceeding 55-65 mm) in patients with Marfan syndrome because there is a high risk of death in this group of patients in the case of dissection.

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.

The quality of life after aortic valve replacement with homografts or prosthetic valves.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the quality of life in patients after homograft or prosthetic aortic valve implantation. Evaluation was based on clinical and echocardiographic examinations, and on analysis of data from patient questionnaires. METHODS: Patients undergoing either homograft (HV, n = 220) or prosthetic (PV, n = 220) aortic valve replacement were investigated. The patients groups were similar in age, sex, follow up period, risk factors and type of heart defect, and did not demonstrate any dysfunction of the replacement valve. RESULTS: During both pre- and postoperative periods, no significant inter-group differences were identified with regard to the occurrence of retrosternal pain, dyspnea, palpitation, fear reaction and circulatory efficiency based on NYHA classification, and self-evaluation of physical activity assessed by patient questionnaires. The majority of patients in both groups noticed on increase in their quality of life and physical activity. The reduced sexual activity (50%) and fear reaction (30%) in both groups did not correlate with their improved sense of well-being. Up to 14.6% of PV patients did not accept the implanted valve, and 65 (29.5%) would have preferred an HV, despite the need for reoperation. Following surgery, 21% of HV patients resumed work, compared with only 7.7% of PV patients. The frequency of claims for disability pension after surgery did not correlate with the considerate clinical and subjective improvement. CONCLUSIONS: In patients receiving either homograft or prosthetic valves, the subjective evaluation of life quality is comparable with the clinical evaluation, though the homograft valve was better accepted than its prosthetic counterpart.

Association of Helicobacter pylori infection with coronary heart disease.

The role of Helicobacter pylori (HP) as the main etiological factor in gastritis and peptic ulcer disease is undisputable. Gastric mucosal damage caused by HP involves various bacterial and host-dependent toxic substances that have been recently associated with an increased risk of coronary artery disease (CAD), possibly through the activation acute phase response and of procoagulant hemostatic factors. Recent studies showed a close and strong correlation between plasma increments of some cytokines such as IL-6 or TNFalpha and cardiovascular diseases. HP infection induces platelet activation and aggregation that could be the pathogenic explanation of the association between HP infection and CAD. The aim of this study was to determine the seroprevalence of HP infection and antibodies to CagA, an antigen that is expressed by the most virulent HP strains inducing an enhanced gastric inflammatory response, in patients undergoing routine coronary artery examination. We studied 76 patients with CAD and 81 healthy controls patients without significant change in coronary circulation. Angiograms were read by two independent experienced cardiologists blinded to the results of HP status. The presence of serum IgG antibodies to HP and to CagA and plasma interleukin-8 (IL-8) levels was measured by ELISA. In addition plasma C-reactive protein fibrinogen, total cholesterol and lipids levels were measured in all studied patients. Seropositivity to HP was found in 81.5 % of cases and in 51% of controls and the difference in prevalence was statistically significant, the odds ratio being 4.3 for Hp patients. Antibody to CagA protein was detected in 47.3% of CAD but only in 28% of healthy controls (OR = 2.3 vs OR = 10). C-reactive protein, plasma fibrinogen and total cholesterol were, respectively higher in patients with CAD than in controls. Present data show that there is significant link between CAD and HP infection. The HP infection significantly increases the risk of CAD, especially when both the anti-HP IgG and anti-CagA IgG are considered. Higher prevalence of cytotoxic HP strains might enhance the atherosclerotic process by inducing a persistent, low grade inflammatory response in arterial wall with enhanced synthesis of acute phase reactants.

Comparative analysis of prosthetic heart valve replacement on the basis of 300 cases.

1. The 224 patients have been followed-up for postoperative intervals of 1 to 8 years after operation, and the average duration of the follow-up has been 4 years. 2. Six types of heart valve prostheses have been utilized and evaluated with the longest (9 years) period of follow-up (a Starr-Edwards prothesis) and the shortest a Björk-Shiley valve. The best clinical hemodynamic characteristics, no thromboembolic complications were observed with the Lillehei-Kaster valve. Evaluation of longterm wear and thrombosis require further follow-up studies. 3. All patients, but 21, improved in functional capacity and are NYHA class I and II. Most of the patients had heart failure at the time of operation. These patients would have had a life expectancy of about two years from the onset of symptoms. Seventy two patients with heart failure as a prime symptom have thus outlived their anticipated life expectancy. 4. Systemic embolization was the most common postoperative complication in spite of the anticoagulant therapy.

Successful full-term pregnancy in a patient three and a half years after a heart transplant.

The patient is a 28 year old woman who received a heart transplant in 1992 secondary to hypertrophic cardiomyopathy with unremarkable post-operative course. In the period immediately post transplantation the patient was on a four-drug immunosuppressive regimen which was subsequently changed to standard three-agent therapy. This therapy was continued until the patient became pregnant. In the first trimester only Cyclosporine (CsA) was used, and thereafter, the patient was continued on the previous three agent regimen. Toward the end of pregnancy a rise in systolic pressure was observed, but the child was delivered by spontaneous vaginal delivery without complications in the 38th week of pregnancy. The newborn weighed 3320 g and was in good health. A sharp fall in the newborn CsA blood levels was observed post delivery reaching zero level on the third day of life. At the present time, both mother and baby are in good health, 6 weeks after delivery.

Ambiguity of morphological criteria of myocarditis in cardiac biopsy specimens.

Myocarditis is diagnosed when leukocytic infiltrate is accompanied by myocyte degeneration or necrosis. Endomyocardial biopsy is evaluated as the main diagnostic method. The purpose of the present study was to examine the individual elements of a histological picture and specify morphological criteria of diagnosing myocarditis in cardiac biopsy. The Dallas criteria were the point of reference. In the cardiobiopsies from 70 patients with clinically suspected myocarditis or congestive cardiomyopathy an active myocarditis was found in 19 cases, significantly more frequently in the group clinically classified as having myocarditis. Contraction bands, endocardial changes and vasculopathy were more frequent in cases histologically classified as active myocarditis than in borderline myocarditis. In our opinion the Dallas criteria include certain ambiguities concerning mainly differences of individual types and phases of myocarditis as well as their relations to congestive cardiomyopathy. The sensitivity and specificity of the diagnosis are related both to methodological limitations (material selection) and difficulties occurring mainly at the level of perception, evaluation and interpretation of changes. It is possible to improve the efficacy of cardiac biopsy in diagnosing myocarditis if a new techniques better revealing myocyte damage and more unequivocally determining the cellular composition of the stroma have been developed.

[Morphology of atheromatous change during and after PTCA and occurrence of restenosis]. / Morfologia zmiany miazdzycowej przed i po PTCA a wystapienie restenozy.

The frequency of restenosis incidence in a group of 72 patients after effective PTCA as well as dependence of its incidence on dilated coronary artery and morphology of sclerotic changes according to ACC/AHA classification were analyzed. The subject of analysis included also effect of the degree of residual stenosis on restenosis incidence as well as determining dependence between the degree of dissection after PTCA on restenosis rate. Restenosis was stated in 20 (20.7% percent) patients, in 26 cases (29%) among 88 dilated coronary arteries. Restenosis was more frequently observed in cases of left coronary artery dilatation. Analyzing restenosis occurrence in relation to morphology of sclerotic changes according to ACC/AHA classification its more frequent incidence in type B (35%) and type C (44%) in comparison type A--25% of this classification was observed. The percentage of residual stenosis was higher in the group of restenosis and amounted to 22.8% in comparison to the residual stenosis of 13% in the group of patients with no reported restenosis. Localized dissection can be a good predictor of results after successful PTCA. More frequent incidence of limited dissection took place in 34% of dilated coronary arteries without restenosis in relation to 20% of cases with restenosis. No evidence of dissection as well as long dissection after PTCA was associated with higher degree of restenosis. Angiographic evaluation of the morphology of sclerotic changes in view of degree of dissection after PTCA is a good predictor of results after angioplasty.

[Myocardial infarction in pregnancy]. / Zawal serca w czasie ciazy.

We report two cases of pregnant women who developed an acute myocardial infarction. The proposed cause of massive myocardial anterior and interventricular wall infarction of the first patient appears to be bacterial intracoronary thrombus during the course of bacterial endocarditis. Acute insufficiency of the mitral valve caused by rupture chordae tendineae of the anterior mitral left was another complication. Labor contractions occurred on the 13th day of treatment. On the next day the patient gave birth to a healthy child by elective cesarean section. She was also qualified for an operation because of increased signs of left ventricular heart failure. Preoperative coronary angiography revealed occlusion of the anterior descending branch and reconstruction of its periphery. Other vessels were not changed. The patient was subjected to implantation of artificial valve, an aortocoronary by-pass and repair of atrial septal defect. Eighteen months follow up was uneventful. The second case was a 29 year-old pregnant woman who had previously undergone mitral commissurotomy admitted because of an acute myocardial infarction in the II trimester. No complication of the disease was observed.

[Value of echocardiography in detection of vegetation and their clinical significance]. / Wartosc echokardiografii w wykrywaniu wegetacji i ich znaczenie kliniczne.

The aim of the study was to assess usefulness of echocardiography in bacterial vegetations detection as well as their clinical value as the indicator for surgical treatment. 44 patients aged 16-65 (mean 37.6) with infective mitral and aortic valve endocarditis underwent the study. Authors assessed clinical state taking into consideration blood culture tests as well as M-mode and parasternal and apical projections two-dimensional echocardiographic examinations. Data were compared with intraoperative or pathomorphological findings to estimate specificity and sensitivity of echocardiography in bacterial vegetation detection. Vegetations were pathomorphologically or intraoperatively stated in 21 patients (48%). M-mode echocardiography revealed changes in 16 patients, and two-dimensional one in the next 3. In the group of 23 patients without vegetations, concordance between intraoperative findings and echocardiographic results was stated in 19 subjects. Therefore, sensitivity and specificity of two-dimensional echocardiography were respectively 91% and 83%. Vegetations stated in two-dimensional echocardiographic examination had an unfavourable prognosis. Embolic complications were observed in 14, and myocardial infarction in 7 of 21 patients with bacterial vegetations. Authors thought it advisable to early operate on such patients. Whereas in patients without vegetations embolic complications were stated only in 3, and myocardial infarction in 1 patient. Therefore two-dimensional echocardiography making bacterial vegetations detection possible in patients with infective valve endocarditis allows to identify patients with higher risk of thromboembolic complication or death.

[Results and complications of PTCA]. / Wyniki i powiklania angioplastyki wiencowej.

Between January 1987 and June 1992 we performed 189 PTCA procedures in a group of 153 patients (127 men, 26 women) aged 28 to 69 years, mean 52.3. 203 coronary vessels were dilated. In 136 pts one vessel was dilated, one vessel with two narrowings were dilated in 16 pts and in 17 pts two-vessel PTCA was performed. Due to restenosis, PTCA was repeated, once in 26 pts, twice in 3 pts and three times in 1 patient. Effective dilatation was achieved in 81.8% of cases and in this number, circumflex and marginal branch of left coronary artery were successfully dilated in 90.7%, left anterior descending in 84.6%, right coronary artery in 84.2% of cases. Attempts to recanalize these vessels were effective in 52%. There were no lethal complications of PTCA, acute occlusion of artery occurred in 5.9% of dilated vessels. Emergency coronary bypass had to be performed in 5.2% pts due to acute artery occlusion. PTCA supported by surgical stand-by appears to be a safe procedure with high direct effectiveness.

[Quality of life in patients after implantation of pacemaker type DDD]. / Samoocena jakosci zycia chorych po wszczepieniu rozrusznika serca typu DDD.

The aim of this study was to evaluate quality of life in pts with DDD pacemakers. The study group consisted of 343 pts (181 F, 162 M), mean age 66.7 +/- 2.5 y (19-92) in whom DDD pacemakers were implanted in the years 1992-1998 due to sick sinus syndrome (213 pts) or AV block (130 pts). Follow-up period was 111-2574 days, mean 924.58 +/- 550 days. The QOL assessment was based on the questionnaire prepared at our Center. The questionnaires were mailed to the pts. The significant improvement in overall well-being (p < 0.001), physical capacity (p < 0.005) and concentration (p < 0.025) was found as compared to the time before implantation. The incidence of syncopy decreased after implantation (p < 0.001). The pts complained of: limitation of arm moving (50.1%), anxiety for disturbances of PM function (41.4%), resignation from job (17.2%), restriction of sport activity (15.7%), necessity for follow-up visits (15.7%) and limitation of sex activity (10.2%). There were not significant differences in QOL between pts paced due to SSS or AV block. We found significant improvement in QOL after implantation of DDD pacemakers. The questionnaire-based assessment of QOL may be useful in management of DDD-paced pts.

[Use of tissue Doppler echocardiography]. / Zastosowanie tkankowej Dopplerowskiej echokardiografii.

Tissue Doppler Echocardiography (TDE) is a new noninvasive technique which shows myocardial tissue by color-mapping. It's based on the color Doppler and used to assess in a direct way left ventricular systolic and diastolic function. It helps to measure velocities, acceleration and energy signal within the myocardial wall. The transmural gradient of velocities can be calculated too. TDE can be used to detect regional systolic dysfunction due to myocardial ischemia and viable myocardium. It gives specific view of intracardiac structures and is useful for identification tumors, thrombus and vegetations.

[Exercise tests and respiratory gas analysis in cardiology. Testing procedure and selected parameters needed for evaluation of cardiopulmonary system function]. / Badania wysilkowe z analiza gazów wydechowych w kardiologii. Schemat badania i wybrane parametry konieczne do oceny wydolnosci ukladu krazenia.

The analysis of data obtained during cardiopulmonary test at rest and during progressively increasing work rate exercise testing can be used to determine accurately cardiac functioning and cell respiration. The cardiopulmonary exercise testing (CPX) should be carried out according to the detailed description of testing procedures. The pre-test provides the patient with practical trials and instruction. The next stages of the testing are: the rest (preparing the patients, resting spirometry), warm-up (resting metabolism), exercise of incremental work rate, recovery. The aim of the paper is to present the main parameters: maximal oxygen uptake (VO2max), anaerobic threshold (AT), threshold of the decompensated metabolic acidosis (TDMA), heart rate reserve, oxygen pulse (O2-puls), tidal volume (VT), breathing reserve, physiologic dead space and tidal volume ratio (VD/VT). Our objective is to familiarize the reader with the most modern examination methods which allow for evaluation of disorders in cardiovascular and pulmonary systems. CPX eliminates subjective evaluation which makes easy the diagnosis and estimation of the results of the treatment of many diseases.

[Assessment of the left ventricular function by tissue Doppler echocardiography]. / Ocena czynnosci lewej komory przy uzyciu tkankowej echokardiografii dopplerowskiej.

UNLABELLED: Myocardial velocity gradient is a new indicator of regional left ventricular contraction determined by a two dimensional tissue Doppler imaging technique. The main goal of this study was to compare myocardial velocity gradient in patients with old myocardial infarction and dilated cardiomyopathy to normal subjects. We assessed myocardial velocity gradient in 44 persons: 32 patients (19 men, 13 women, mean aged 51.2 +/- 6.1 years) and 12 healthy subjects (7 men, 5 women, mean age 49.3 +/- 8.3 years) who were divided into 4 groups. Group A--14 patients with old anteroseptal myocardial infarction, group B--7 patients with old posterior infarction, group C--11 patients with dilated cardiomyopathy and group D--12 healthy subjects. In normal subjects myocardial velocity gradient in the anteroseptal segment was mean 2.44 +/- 0.34 s-1 and in the posterior segment was 3.08 +/- 0.38 s-1. Myocardial velocity gradient in the infarct regions was significantly lower than in noninfarct regions as well as that in the corresponding regions in normal subjects. Gradient in the anteroseptal and posterior segments was in group A: 0.61 +/- 0.33 s-1 12.39 +/- 0.65 s-1, p < 0.001 respectively and group B: 2.11 +/- 0.45 s-1 10.91 +/- 0.34 s-1, p < 0.001 respectively. In patients with dilated cardiomyopathy gradient was significantly lower (nteroseptal segment 0.55 +/- 0.37 s-1, posterior segment 0.85 +/- 0.31 s-1) than that in normal subjects (p < 0.001). CONCLUSION: Myocardial velocity gradient is a new indicator for the quantitative assessment of regional left ventricular contraction.