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Background: Excessive lipid accumulation within the myocardial tissue predisposes to ventricular arrhythmias and increased risk of sudden cardiac death. This study aimed to detect intramyocardial fat infiltration in patients with chronic myocardial infarction (MI) using advanced cardiac magnetic resonance (CMR) imaging techniques – fat-water separation and feature tracking. Methods: Twenty patients with chronic MI underwent advanced CMR imaging. The study protocol included conventional cine, late gadolinium enhancement (LGE) and fat-water separation (2-point mDixon) imaging. Left ventricular (LV) circumferential (EccLV) and radial (ErrLV) strain were calculated using dedicated software (CMR42, Calgary, Canada). The extent of global scar tissue was calculated in LGE and fat-water separation images to compare advanced and conventional imaging techniques. Results: The infarct size as derived from conventional LGE and fat-water separation images was similar. However, detection of intramyocardial fat was only possible with fat-water separation imaging. Subjects with intramyocardial fat deposition demonstrated significantly smaller percentage of fibrosis than those without fat deposition (10.68 ± 5.07 % vs. 13.83 ± 6.30 %; p = 0.005). There was no significant difference in LV circumferential (EccLV) and radial (ErrLV) strain between myocardial segments containing fibrosis only and fibrosis with fat deposition (-11.94 ± 5.92 % vs. -12.63 ± 7.14 %; p = 0.668 for EccLV and 20.85 ± 16.48 % vs. 17.89 ± 12.43 %; p = 0.607 for ErrLV). Conclusions: Advanced CMR imaging enables more detailed tissue characterization in patients with previous MI without relevant increase in examination or post-processing time. LGE and myocardial feature tracking techniques are unable to detect intramyocardial fat deposition.

Objectives: Cardiovascular magnetic resonance feature tracking (CMR-FT) is a novel tissue tracking technique developed for noninvasive assessment ofmyocardial function. This study aimed to assess the long-term effect of mitral valve repair in patients with severe primarymitral regurgitation (MR). Methods: Ten patients with severe primary MR were consecutively enrolled and underwent CMR with a 1.5 T MRI scanner (Siemens Magnetom Aera, Germany) before surgical mitral valve repair and one-year after surgery. Myocardial deformation was analyzed using a dedicated software (Medis Suite, The Netherlands). Left ventricular (LV) longitudinal strain (EllLV) was calculated from three long-axis (2-chamber, 3- chamber and 4-chamber) cine images and circumferential and radial (EccSAX, ErrSAX) strain were derived from three short-axis (basal, mid-ventricular and apical) cine images. Results: There was significant decrease in EllLV at one-year follow-up when compared with strain estimated before surgery (EllLV: -21.89 6 4.70% before surgery vs. -17.76 6 4.01% after surgery; p¼0.028). Also, there was significant decrease in ErrSAX (55.87 6 14.72% before mitral valve repair vs. 33.12 6 8.54% after valve repair; p¼0.015). The EccSAX at one-year follow-up was similar when compared withmeasurements derived before surgery (p¼0.374). Conclusion: Conclusion. Mitral valve repair surgery in patients with severe primary mitral regurgitation reduces LV longitudinal and radial strain assessed by CMR-FT.

Acute myocardial infarction complicated by cardiogenic shock is one of the main reasons of death in severely ill patients. One of the main indications for intra-aortic balloon counterpulsation is acute myocardial infarction complicated by cardiogenic shock. Aortic counterpulsation is associated with the risk of several important complications: bleeding, thrombosis, thrombocytopenia, limb ischemia, and aortic wall damage. The analysis of complications is necessary to better understand the course of myocardial infarction using aortic counterpulsation and to reduce the risk of complications. The aim of the study was to analyze the course of acute myocardial infarction complicated by cardiogenic shock in patients managed by intra-aortic balloon counterpulsation as well as to determine intra-aortic balloon counterpulsation-related complications. Material and Methods. The course of acute myocardial infarction complicated by cardiogenic shock in patients with aortic counterpulsation was analyzed. Patients were recruited from the Cardiology Intensive Care Unit, Department of Cardiology, Lithuanian University of Health Sciences, during the period of 2004–2010. The study comprised 73 patients: 30 women (41.1%) and 43 men (58.9%). Results. Atrial fibrillation and asystolia were the most common cardiac complications during counterpulsation. Atrioventricular block was the predominant disorder of cardiac conduction system; acute renal failure was the most common noncardiac complication. Complications such as major bleeding, infection, aortic wall damage, or amputations were not documented in our study. Successful percutaneous coronary intervention was associated with fewer complications and reduced mortality rate. Conclusions. Aortic counterpulsation may be successfully employed providing significant hemodynamic support with rare major complications in a high-risk patient population. [...].

Objective. The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block. Materials and methods. Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary angiography were enrolled in the study. Findings of these imaging modalities were compared in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography in identifying hemodinamically significant stenoses (³50%). All segments ³2 mm in diameter were visually assessed independently from their degree of calcification and image quality. Results. In total, 328 segments were analyzed. The Spearman correlation coefficient between multislice computed tomography and invasive coronary angiography was 0.76 (P

Exercise cardiography still remains the cornerstone of noninvasive evaluation of functional status of cardiovascular system and is almost uniformly performed after myocardial infarction. The patients after myocardial infarction can be divided into relative high- and low-risk groups for subsequent cardiac events if all information available on the exercise test is used. Objective. The aim of this study was to evaluate the prognostic significance of the shape of heart rate and systolic blood pressure curves (their dynamic characteristics) during the early exercise testing and after it and to design the prognostic system capable to recognize patients with a high risk of coronary death during 2 years after myocardial infarction. Material and methods. The submaximal exercise testing within 3 weeks of acute myocardial infarction was performed on 894 patients. Cases of noncardiac deaths or patients subjected to coronary bypass surgery were excluded from the further analysis. At the end of 2 years after myocardial infarction, there were 426 survivors and 42 cases of cardiac death. At 2-year follow-up after infarction in the nonsurvivor group, there were only 42.2% of patients with exercise-induced ST segment depression. This shows that prognostic importance of ST depression is insufficient and demands research of more consistent signs. Results. The cardiovascular response to exercise was interpreted as transiting process of self-regulation of cardiovascular system, and the new predictive signs were found based on the curves of heart rate and systolic blood pressure during the exercise and after it. The prognostic value of these signs was established. The combined use of both the new predictive signs and usual data of early exercise test shows the high predictive possibility of test – the early cardiac death was predicted in 80% of cases [...].

Objective. Many studies report that the components of the metabolic syndrome – arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia – are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes. Methods and results. The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3±11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (≥6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components. Conclusion. More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome.

During the last decade, it has been shown that the metabolic syndrome and its different components – arterial hypertension (AH), abdominal obesity (AO), diabetes mellitus (DM), atherogenic hypertriglyceridemia (HTG), and/or low concentration of high-density lipoprotein cholesterol (HDL-C)) – increase the risk of cardiovascular diseases. There is increasing evidence that the incidence of the metabolic syndrome and the distribution of its components in combinations in the general male and female population differ. The aim of our study was to determine the incidence of the metabolic syndrome in men and women with acute ischemic syndromes and to evaluate the distribution of the metabolic syndrome component combinations in the presence of the metabolic syndrome. Contingent and methods. The study included 2756 patients (1670 males and 1086 females) with acute ischemic syndromes (1997 with myocardial infarction and 759 with unstable angina pectoris), in whom all five components of the metabolic syndrome were assessed. Women were significantly older than men (68.1±9.5 vs. 60.2±11.8 years, P

Prediction of outcomes after acute myocardial infarction was initiated more than 40 years ago. Improvement of the management options significantly reduced mortality of patients with acute myocardial infarction. In the 1960s, the mortality rate of inpatients was around 25–30%, whereas in 2007, according to the guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes, issued by the European Society of Cardiology, hospital mortality in patients with ST-elevation acute myocardial infarction was 7%, while in patients with non-ST-elevation acute coronary syndrome just 5%, but at 6 months, mortality rates were very similar in both conditions (12% vs. 13%, respectively). There are different criteria for prediction of acute myocardial infarction: demographic, clinical, laboratory, instrumental, and epidemiological. Data of hemodynamic studies are ones of the possible criteria for prediction of outcomes after acute myocardial infarction. Methods and findings of hemodynamic studies used for prediction of the outcomes are presented in this article.

The aim of the article is to review the literature data about the significance and problems of the QT dispersion and heart rate variability in sudden death risk stratification in patients with coronary heart disease. QT dispersion is defined as the difference between the longest and the shortest QT intervals as measured in the 12-lead electrocardiogram. A direct relationship between the prolongation of QT dispersion and myocardial ischemia has been reported by several authors. Our previous study showed that QT dispersion assessed immediately after bicycle exercise test was significantly higher in patients with coronary stenoses of >50% as compared to the patients without coronary artery disease. Despite some controversial data, several studies showed that QT dispersion is a significant predictor of cardiovascular mortality. Heart rate variability representing a relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, is one of the most promising markers. The predictive value of heart rate variability is independent of other factors established for postinfarction risk stratification, such as depressed left ventricular ejection fraction, increased ventricular ectopic activity, and presence of late potentials. For prediction of all-cause mortality, the value of heart rate variability is similar to that of left ventricular ejection fraction, but heart rate variability is superior to left ventricular ejection fraction in predicting arrhythmic events (sudden cardiac death and ventricular tachycardia).

The aim of the article is to review the literature data about the significance and problems of the QT dispersion and heart rate variability in sudden death risk stratification in patients with coronary heart disease. QT dispersion is defined as the difference between the longest and the shortest QT intervals as measured in the 12-lead electrocardiogram. A direct relationship between the prolongation of QT dispersion and myocardial ischemia has been reported by several authors. Our previous study showed that QT dispersion assessed immediately after bicycle exercise test was significantly higher in patients with coronary stenoses of >50% as compared to the patients without coronary artery disease. Despite some controversial data, several studies showed that QT dispersion is a significant predictor of cardiovascular mortality. Heart rate variability representing a relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, is one of the most promising markers. The predictive value of heart rate variability is independent of other factors established for postinfarction risk stratification, such as depressed left ventricular ejection fraction, increased ventricular ectopic activity, and presence of late potentials. For prediction of all-cause mortality, the value of heart rate variability is similar to that of left ventricular ejection fraction, but heart rate variability is superior to left ventricular ejection fraction in... [to full text] Straipsnio tikslas. Apžvelgti literatūros duomenis apie QT dispersijos ir širdies ritmo dažnio variabilumo reikšmę ir problemas įvertinant staigios mirties riziką sergantiesiems išemine širdies liga. QT dispersija apibrėžiama kaip skirtumas tarp ilgiausio ir trumpiausio QT intervalo 12-kos derivacijų elektrokardiogramoje. Kai kurie autoriai nustatė tiesioginį ryšį tarp padidėjusios QT dispersijos ir miokardo išemijos. Ankstesnio mūsų atlikto tyrimo duomenimis, QT dispersija fizinio krūvio maksimumo metu žymiai didesnė ligoniams, kuriems rastas daugiau kaip 50 proc. vainikinių kraujagyslių susiaurėjimas, palyginus su ligoniais, kuriems vainikinių kraujagyslių susiaurėjimas buvo mažesnis nei 50 proc. Nepaisant prieštaringų duomenų, studijos parodė, kad padidėjusi QT dispersija yra požymis, rodantis padidėjusią mirties riziką nuo širdies ir kraujagyslių ligų. Svarbus staigios mirties prediktorius, atspindintis autonominės nervų sistemos įtaką staigiai mirčiai, yra širdies ritmo dažnio variabilumas. Padidėjęs širdies ritmo dažnio variabilumas mirties rizikai turi tokią svarbią reikšmę kaip ir kairiojo skilvelio išstūmimo frakcija, o numatant skilvelinių aritmijų sukeltą staigią mirtį, širdies ritmo dažnio variabilumas yra netgi svaresnis požymis nei kairiojo skilvelio išstūmimo frakcija.

Santrauka. Darbo tikslas. Įvertinti metabolinio sindromo ir jo komponentų paplitimą tarp vidutinio amžiaus Kauno gyventojų. Tirtųjų kontingentas ir tyrimo metodai. Ištirti 433 (192 vyrai ir 241 moteris) 38,8±0,3 metų Kauno miesto gyventojai. Metabolinis sindromas diagnozuotas naudojantis 2005 metų Tarptautinės diabeto federacijos parengta metabolinio sindromo klasifikacija. Nustačius pilvinio tipo nutukimą (vyrų liemens apimtis >=94 cm, moterų >=80 cm) ir esant dar dviem iš šių komponentų: padidėjusiai trigliceridų (Tg) koncentracijai (>=1,7 mmol), sumažėjusiai didelio tankio lipoproteinų cholesterolio (DTL-C) koncentracijai (vyrams – =130 mmHg sistoliniam arba 85 mmHg diastoliniam) bei hiperglikemijai (>=5,6 mmol/l), diagnozuojamas metabolinis sindromas. Rezultatai. Metabolinis sindromas diagnozuotas 21,7 proc. tiriamųjų (28,1 proc. vyrų ir 16,6 proc. moterų). Nagrinėjant atskirus metabolinio sindromo komponentus, nustatyta, kad 41,1 proc. tirtųjų buvo padidėjusi liemens apimtis, 56,4 proc. – padidėjęs AKS, 31,2 proc. – padidėjusi gliukozės koncentracija plazmoje, 19,9 proc. – sumažėjusi DTL-C koncentracija ir 14,1 proc. – padidėjusi Tg koncentracija. Tiriamiesiems, kuriems diagnozuotas metabolinis sindromas, didelio jautrumo C reaktyviojo baltymo koncentracija buvo 1,16 mg/l didesnė (α=94 cm for men and >=80 cm for women) plus any two of the following four factors: elevated triglycerides (Tg) (>=1.7 mmol/L), low high-density lipoprotein cholesterol (HDL-C) levels (130 mmHg or a diastolic pressure >85 mmHg) or hyperglycemia (>=5.6 mmol/L). Results. The metabolic syndrome was present in 21.7% (28.1% among males and 16.6% among females) of individuals. Furthermore, 41.1% had an increased waist circumference, 56.4% had elevated BP (130/85 or higher), 31.2% had elevated plasma glucose concentration, 19.9% had low HDL-C cholesterol values and 14.1% had increased Tg values. Significantly higher concentration (1.16 mg/L, α3 mg/L) of high-sensitivity C-reactive protein was more prevalent (17.3%) in the cohort with metabolic syndrome. Concentration of high-sensitivity C-reactive protein directly correlated with the waist and hips circumference... [to full text]

Objective. To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima–media thickness in asymptomatic middle-aged individuals. Materials and methods. A total of 180 subjects (86 men and 94 women, mean age 38.8±0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). Results. The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima–media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (a=0.000, b=0.01). Endothelial dysfunction and intima–media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood triglyceride and glucose levels. Intima–media thickness was greater in individuals with impaired endothelial function in all carotid segments tested. No relationship has been observed between total or low-density lipoprotein cholesterol concentrations and endothelial function, intima–media thickening or high sensitivity C-reactive protein levels [...].

Darbo tikslas. Nustatyti kardialinių įvykių dažnumą bei įvertinti klinikinių žymenų ryšį su išgyvenimo tikimybe penkerius metus po persirgtų skirtingų ūminių išeminių sindromų. Tyrimo medžiaga ir metodai. Prospektyviojoje stebėjimo studijoje analizuojamas 732 ligonių, susirgusių pirmuoju ūminiu išeminiu sindromu, kardialinių įvykių dažnis ir išgyvenimas penkerius metus. Ūminiu išeminių sindromų laikotarpiu visiems ligoniams skirtas standartinis medikamentinis gydymas (heparinu, nitratais, aspirinu, beta adrenoblokatoriais, AKF slopintojais), 45,5 proc. ligonių atlikta miokardo revaskulizacija. Rezultatai. Postacionariniu laikotarpiu 215 (29,4 proc.) nustatyti kardialiniai įvykiai: 15,3 proc. – miokardo revaskulizacija, 8,1 proc. – pakartotinis miokardo infarktas, 11,5 proc. – mirtis nuo širdies ir kraujagyslių ligų. Didžiausias mirštamumas (5 proc.) po persirgtų ūminių išeminių sindromų buvo per pirmuosius vienerius metus, per kitus ketverius metus – vidutiniškai 1,5 proc. kasmet. Išgyvenimo tikimybę reikšmingai mažino buvęs ūminis širdies nepakankamumas (p=0,003), ryški kairiojo skilvelio sistolinė ir diastolinė disfunkcija (p=0,04 ir p=0,0035, atitinkamai), didelis mitralinio vožtuvo nesandarumas (p=0,00006), vyresnis ligonių amžius (p=0,02) ir neatlikta miokardo revaskulizacija ūminių išeminių sindromų laikotarpiu (p=0,007). Išvada. Siekiant prailginti ilgalaikio išgyvenimo trukmę, būtina atrinkti po persirgtų ūminių išeminių sindromų didelės mirties rizikos nuo širdies... [toliau žr. visą tekstą] Objective. To evaluate the incidence of cardiac events and survival in patients with first acute coronary syndromes during 5-year period. Methods and results. Data on 732 patients admitted with first acute coronary syndrome were collected in a database. During hospitalization period 45.4% of the patients received reperfusion therapy. During follow-up period (4.49±2.1 years) 215 (29.4%) patients had cardiac events: 15.3% – myocardial revascularization, 8.1% – repeated myocardial infarction, 11.5% – cardiovascular deaths. The highest (5%) mortality rate was during first year, whereas during the following four years – 1.5% annually. Kaplan–Meier analysis for survival free of cardiovascular death revealed that mortality rates were higher among patients who were 65 years old (long-rank test, p=0.02); had heart failure at admission (p=0.003), left ventricular ejection fraction

Darbo tikslas. Įvertinti ryšį tarp širdies ir kraujagyslių ligų rizikos veiksnių, metabolinio sindromo, endotelio funkcijos sutrikimo bei miego arterijų intimos ir medijos storio vidutinio amžiaus asmenims. Tyrimo kontingentas ir metodai. Tirti 180 (86 vyrai ir 94 moterys), 38,8±0,3 metų Kauno miesto gyventojai. Atlikti antropometriniai, arterinio kraujospūdžio matavimai, kraujo lipidų, glikemijos, didelio jautrumo C reaktyviojo baltymo tyrimai. Endotelio funkcija tirta vertinant žasto arterijos vazodilataciją. Ultragarsiniu metodu matuotas miego arterijų intimos ir medijos storis. Metabolinis sindromas diagnozuotas remiantis Tarptautinės diabeto federacijos (2005) parengta klasifikacija. Rezultatai. Metabolinis sindromas nustatytas 48 (26,7 proc.): 28 (32,6 proc.) vyrams ir 20 (21,3 proc.) moterų. Keturiasdešimtmečių vyrų endotelio funkcija: mažesnė tėkmės sukelta ir nuo nitroglicerino priklausoma vazodilatacija buvo blogesnė negu to paties amžiaus moterų. Statistiškai reikšmingai mažesnė (4,84 proc.) tėkmės sukelta vazodilatacija nustatyta tik vyrams, sergantiems metaboliniu sindromu. Sergančiųjų metaboliniu sindromu intimos ir medijos storis buvo reikšmingai didesnis negu asmenų, nesergančių metaboliniu sindromu: bendrojoje miego arterijoje intimos ir medijos storio skirtumas buvo 0,006 cm, miego arterijos bifurkacijoje – 0,007 cm ir vidinėje miego arterijoje – 0,007 cm (α=0,000, β=0,01). Endotelio funkcijos sutrikimas bei intimos ir medijos storio padidėjimas koreliavo... [toliau žr. visą tekstą] Objective. To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima–media thickness in asymptomatic middle-aged individuals. Materials and methods. A total of 180 subjects (86 men and 94 women, mean age 38.8±0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). Results. The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima–media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (α=0.000, β=0.01). Endothelial dysfunction and intima–media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood... [to full text]

The article analyses clinical characteristics and mortality of patients with symptomatic chronic heart failure following Q-wave myocardial infarction. During the study 224 patients (mean age 64.1±9.7) with symptomatic chronic heart failure and left ventricular ejection fraction

The aim of the study was to evaluate changes of ventricular repolarization variables during the exercise test in women with coronary heart disease, to determine variables, which can best predict significant coronary artery stenoses, and to improve noninvasive diagnostics of coronary heart disease. Ninety women with unstable angina pectoris undergone coronary artery angiography and exercise test on 4th–6th day of hospitalization at Kaunas University of Medicine Hospital. There was no difference in ventricular repolarization variables (JT interval, JT dispersion, JT and ST product) in women without coronary artery stenoses and those with one or two coronary artery stenoses. Sensitivity (87%), specificity (60%), positive predictive (43%), negative predictive (93%) and diagnostic value (67%) of stress test variable, which had no correlation with heart rate –ST and JT product– was greater comparing with ST depression greater than 0.1 mV (values respectively 61%, 49%, 29%, 79%, 52%). JT dispersion at the peak of exercise greater than 33 ms had the best diagnostic value (77%). The most accurate predictors of three-vessel disease are JT dispersion, ST and JT product at the peak of exercise and the fact of previous MI: · JT dispersion at the peak of exercise more than 33 ms significantly increases three-vessel disease odds ratio 7.95 times. · ST and JT product greater than 22,38 mV·ms significantly increases three-vessel disease odds ratio 13.9 times. · The fact of previous MI significantly increases three-vessel disease odds ratio 6.85 times.

Increased blood cholesterol concentration is one of the main factors in ischemic heart disease, development of which is determined by atherosclerotic changes in coronary vessels. Diet and treatment with 3-hydroxi-3-metilglutaril coenzyme A (HMG-CoA) reductase inhibitors helps to reduce low density lipoprotein cholesterol (LDL-Ch) blood concentration up to recommended level of 3.0 mmol/l in most patients but in some patients particularly with familial dyslipidemias cholesterol concentration remains increased even after treatment with maximal doses of lipid-regulating agents or their combinations. The most frequently used mechanical methods of cholesterol removal from blood include the procedures of extracorporeal apheresis. Low density lipoprotein (LDL) apheresis not only significantly reduces the blood concentrations of total cholesterol (TCh), and LDL-Ch, lipoprotein (a) (Lp(a) and fibrinogen but also stops the progression of atherosclerosis in coronary vessels.

Aim. The significance of clinical characteristics during acute phase of coronary syndrome for hospital prognosis is well established. However their prognostic ability and impact on defining risk of lethal outcome during one-year period after acute coronary syndrome in pts with diabetes mellitus is not clarified. Methods. In a prospective one-year study 699 pts with first acute coronary syndrome were studied: 61 with diabetes mellitus and 638 – without diabetes mellitus. We have analyzed their demographic characteristics, risk factors of ischemic heart disease, clinical, echocardiographic, angiographic data. During one year follow up period there were 61 cases of cardiac death. Results. Univariate analysis showed, that pts with diabetes mellitus vs pts without diabetes mellitus more often were female, aged >65 years, had arterial hypertension, obesity and sinusal tachycardia, severe acute left ventricular failure, three – vessel coronary disease, episodes of paroxysmal atrial flutter during acute phase of acute coronary syndrome (p

Cocaine abuse has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. The first report of myocardial infarction temporally related to the recreational use of cocaine appeared in 1982. This article discusses the possible pathological mechanisms underlying the pathogenesis of myocardial ischemia and infarction secondary to cocaine abuse, and current ideas on the management of cocaine-induced myocardial infarction. We report a case of acute myocardial ischemia in a young healthy male patient and his 5-year follow-up.

ObjectiveCardiac disease is a major cause of maternal mortality. Data regarding pregnancy outcomes in women with a systemic right ventricle (sRV) are scarce. We studied pregnancy outcomes in women with an sRV after the atrial switch procedure for transposition of the great arteries (TGA) or congenitally corrected TGA (CCTGA).MethodsThe ESC EORP Registry of Pregnancy and Cardiac Disease is an international prospective registry of pregnant women with cardiac disease. Pregnancy outcomes (maternal/fetal) in all women with an sRV are described. The primary end point was a major adverse cardiac event (MACE) defined as maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischaemic coronary event and other thromboembolic events.ResultsAltogether, 162 women with an sRV (TGA n=121, CCTGA n=41, mean age 28.8±4.6 years) were included. No maternal mortality occurred. In 26 women, at least one MACE occurred, heart failure in 16 (9.8%), arrhythmias (atrial 5, ventricular 6) in 11 (6.7%) and others in 4 (2.5%). Prepregnancy signs of heart failure as well as an sRV ejection fraction ConclusionThe majority of women with an sRV tolerated pregnancy well with a favourable maternal and fetal outcome. Heart failure and arrhythmias were the most common MACE.

Study aims. To investigate LV myocardial deformation parameters and aortic distensibility in patients with obstructive and non-obstructive hypertrophic cardiomyopathy using cardiac magnetic resonance (CMR) imaging. Methods. Thirty-seven individuals (18 HCM patients without LV outflow tract or mid-ventricular ob-struction and 19 patients with (HOCM) obstruction) underwent CMR imaging. The cine images were used to calculate LV longitudinal, circumferential and radial strain using feature tracking (FT) tech-nique. Global and regional (septal and lateral wall) longitudinal strain was derived from three long-axis cine images, while global and regional (septal and lateral wall) circumferential and radial strain were calculated from three short-axis cine images using dedicated software. Aortic distensibility was calcu-lated using dedicated equation including estimation of maximal and minimal area of descending tho-racic aorta and calculation of absolute aortic area change. Data analysis was performed using IBM SPSS Statistics version 21.0 software. Results. There was no significant difference in global LV longitudinal, circumferential and radial strain between HCM and HOCM patients. Regional myocardial deformation analysis (septal segments vs. lateral wall segments) demonstrated significantly lower septal circumferential and radial strain compared with lateral wall strain in both (HCM and HOCM) groups. The longitudinal strain analysis showed that septal longitudinal strain is significantly reduced when compared with lateral wall seg-ments in patients with HOCM, but not HCM. There was no significant difference in aortic distensibil-ity between HCM and HOCM subjects. Conclusions. Global LV strain values are similar in patients with obstructive and non-obstructive HCM whereas regional circumferential and radial strain is significantly reduced in septal segments when compared with lateral wall segments. Septal longitudinal strain is significantly lower in HOCM subjects, but not those with HCM. Aortic distensibility in patients with HCM and HOCM is similar.

The aim and objectives of the study. The aim of the study. The aim of our study is to assess advantages and reproducibility of myocardial deformation parameters derived using cardiovascular magnetic resonance feature tracking technique in experimental animal (mouse) model and patients with acute and previous myocardial infarction. The objectives of the study. 1. To assess inter- and intra-observer agreement of CMR feature tracking derived strain measurements in mice and define sudy sample size necessary for future trials. 2. To assess changes in myocardial tissue after myocardial infarction using advanced CMR imaging (nDixon) and investigate changes in global and regional myocardial deformation in patients with old myocardial infarction and lipomatous metaplasia. 3. To evaluate left atrial performance during acute ischemia and mitral regurgitation. Also, to assess inter- and intra-observer variability of CMR feature tracking derived left atrial strain and strain rate measurements.

Right ventricle (RV) dysfunction is associated with poor clinical outcomes and it‘s early detection is of critical importance in daily clinical practice. Magnetic resonance imaging is a technique that is becoming widely used, which allows for detection of the global and regional myocardial function, myocardial edema, scar size, as well as measures of prognostic significance: myocardium at risk, myocardial salvage, and microvascular obstruction. With the development of myocardial feature tracking in 2009, came the era of precise deformation measurements in CMRI. The aim of this study was to evaluate longitudinal and transverse strain and strain rate of RV free wall in patients with acute inferior ST segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) feature tracking.A total of 37 subjects were included in this study and underwent CMR analysis. TomTec 2D Cardiac Performance Analysis software was used to asses the strain and strain rate of the subjects. Statistical analysis was performed using the IBM SPSS statistics 20 software. The longitudinal strain of the free wall (EllDS) as well as longitudinal strain rate (SRllDS) were the same between the groups. Patients with acute inferior STEMI demonstrated lower mean RV free wall transverse strain (ErrDS, 23,3 ± 9,3 vs 12,1 ± 8.66, p=

Disertacijoje iškelta sergančiųjų ūminiu miokardo infarktu ir cukriniu diabetu asmenų nepalankios ligos eigos problema bei apžvelgos galimybės prognozuoti tokių asmenų ligos baigtis.Darbo uždaviniais buvo: 1) įvertinti širdies ritmo variabilumo ir hemodinamikos žymenis sergantiesiems ūminiu miokardo infarktu bei cukriniu diabetu priklausomai nuo ligos eigos ir baigčių, palyginti juos su nesergančiųjų cukrininu diabetu atitinkamais žymenimis; 2) nustatyti sergančiųjų miokardo infarktu prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę mirties, skilvelinės aritmijos, grįžtamosios išemijos išsivystymui ar jungtinei vertinamajai baigčiai stacionare; 3) nustatyti prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę per 1 metus ir per 5 metus po persirgto miokardo infarkto įvykusiems: mirčiai dėl bet kokios ir dėl širdinės priežasties, pakartotino miokardo infarkto išsivystymui, neplanuotos širdies revaskuliarizacijos procedūros atlikimui, nekomplikuotos išeminės širdies ligos eigos buvimui; 4) nustatyti ar prognozinė širdies ritmo variabilumo ir hemodinamikos žymenų vertė analizuojamoms baigtims skiriasi tiriamųjų grupėse: a) cukriniu diabetu sergančiųjų asmenų, b) cukriniu diabetu nesergančiųjų asmenų; 5) gautų prognozinių modelių diskriminuojančias savybes palyginti tarpusavyje ir su pripažintais ūminio miokardo infarkto rizikos vertinimo kriterijais (kairiojo skilvelio išstūmio frakcija, GRACE ir TIMI rizikos vertinimo skalėmis). Unfavourable outcomes of the diabetic patients with acute myocardial infarction were analysed in the dissertation and possibilities to predict the course of the disease was reviewed. The objectives of the study were: 1) to evaluate the measures of heart rate variability and impedance cardiography for the patients with acute myocardial infarction, and their alterations in reliance on the different outcomes, according to the patients’ status of diabetes mellitus; 2) to determine prognostic value of combined assessment of heart rate variability and impedance cardiographymeasures for in-hospital outcomes of myocardial infarction: in-hospital mortality, ventricular arrhythmia, recurrent ischemia and complicated in-hospital course; 3) to determine prognostic value of combined assessment of heart rate variability and impedance cardiography measures for long-term (1 and 5 years) outcomes after myocardial infarction: mortality (both all-cause death and cardiac death), ischemic complications (recurrent non-fatal myocardial infarction and need for revascularization procedures) and uncomplicated long-term course; 4) to assess whether prognostic value of combined heart rate variability and hemodynamic measures differs in separate patient groups: diabetic or non-diabetic; 5) to compare the discriminative power of the obtained prognostic models and widely recognized risk markers, such as ejection fraction of the left ventricle, GRACE and TIMI scores.

Supraventrikulinės grįžtamojo ryšio tachikardijos vaikams yra gana dažnas širdies ritmo sutrikimas, kurį sąlygoja papildomi laidumo pluoštai (Kento, Mahaimo), atrioventrikulinės jungties dviejų takų – lėtojo ir greitojo -fiziologiniai ypatumai. Iki gydymo radiodažnine (RD) energija eros, kurios pradžia – 1980 - tieji metai (vaikų amžiuje – 1990 - tieji metai), tachiaritmijų gydymas kėlė daug problemų (ne visuomet efektyvus medikamentinis gydymas, „atviros” širdies operacijos). Mūsų klinikoje pirmoji radiodažninė abliacija (RDA) vaikui atlikta 1991 metais. Pastaruoju metu dėl grįžtamojo ryšio supraventrikulinių tachikardijų (SVT) Kauno klinikose vaikams per metus atliekama apie 20 – 30 tokių procedūrų. Šio gydymo metodo efektyvumas bei mažas komplikacijų skaičius lėmė, kad gydymas RDA tapo pasirinktinu gydymo metodu, gydant SVT. Sukaupta nemažai duomenų apie ankstyvojo ir vėlyvesniojo laikotarpio (praėjus po RDA operacijos 1-29 mėn.) pacientų išgyvenamumą, komplikacijas, širdies ritmo variabilumo pokyčius, kai kuriuos širdies morfometrijos ir funkcijos rodiklius: vožtuvų būklę, įprastinius sistolinę ir diastolinę funkciją atspindinčius rodiklius. Tačiau nėra žinoma apie širdies laidžiosios sistemos, širdies ritmo, ritmo variabilumo pokyčius vėlyvuoju laikotarpiu (praėjus po gydymo RDA daugiau nei dvejiems metams). Pagal šiuos duomenis, retrospektyviai, t.y. jau pagydžius pacientą, galima spręsti apie širdies laidžiosios sistemos ypatumus. Šios žinios reikalingos tiek vaiko... [toliau žr. visą tekstą] The supraventricular tachycardias (SVT) (atrioventricular reentrant tachycardia due to accessory pathways, atrioventricular nodal reentrant tachycardia) are common in children. It is the most common arrhythmia in Wolff –Parkinson White syndrome. The electrophysiologic – morphologic substrates responsible for both AV node reentrant tachycardia (AVNRT) and AV reentrant tachycardia are thought to be present from birth. Radiofrequency ablation (RFA) successfully eliminates the extra pathway by the application of thermal energy typically leaving only normal conduction. The radiofrequency treatment era started in 1980 (and in 1990 for pediatric patients); the treatment of tachyarrhythmia was problematic until then because drug treatment or open heart surgery were not successful rather frequently. At our clinic, the first RFA for a child was performed in 1991. Nowadays, approximately 20 – 30 RFA procedures per year for children suffering from various types of supraventricular tachycardia are performed in our clinic. This method of treatment is effective and the number of complications is low; therefore, it became a method of choice to treat SVT. Data concerning long-term and short-term survival (1 – 29 months after RFA procedure), complications, changes of heart rhythm variability, certain heart morphometry and functional parameters (including valves function, routine indices of systolic and diastolic function) is rather common. However, alternations of heart conductive system... [to full text]

Vainikinių arterijų tyrimas daugiapjūviu kompiuteriniu tomografu (DKT) į klinikinę praktiką įdiegtas nesenai. Tai neinvazyvus tyrimo metodas, kurį galima atlikti ir ambulatoriniams pacientams. Tačiau greta savo privulumų, jis turi ir trūkumų – dėl nuolatinio vainikinių arterijų judėjimo širdies ciklo metu gali atsirasti liekamųjų judesio artefaktų atkuriant vaizdus. Jų tikimybė priklauso ne tik nuo aparato, kuriuo atliekamas tyrimas, techninių charakteristikų, bet ir nuo širdies veiklos ypatumų. Yra atlikta nemažai tyrimų, įvertinančių vainikinių arterijų vaizdų kokybės priklausomybę nuo širdies susitraukimų dažnio, jo variabilumo, kitų faktorių. Kairiosios Hiso pluošto kojytės blokados, sąlygojančios nesinchronišką skilvelių susitraukimą ir atsipalaidavimą, įtaka vaizdų kokybei tyrinėta mažai. Šiame tyrime buvo palyginta vaizdų kokybė tarp pacientų, kuriems nustatyta visiška kairiosios Hiso pluošto kojytės blokada ir nėra laidžiosios sistemos sutrikimų, grupių. Analizuota vainikinių arterijų įvertinimo visuose širdies ciklo rekonstrukciniuose intervaluose įtaka vaizdų kokybės vidurkiui. Nustatyta, kokia yra DKT tyrimo diagnostinė vertė identifikuojant hemodinamiškai reikšmingas vainikinių arterijų stenozes. Kadangi DKT tyrimas susijęs su jonizuojančia spinduliuote, įvertinti rentgeno vamzdžio srovės stiprumo moduliavimo ypatumai. Taip pat nustatyta širdies susitraukimų dažnio, jo variabilumo įtaka vaizdų kokybei, esant visiškai kairiosios Hiso pluošto kojytės blokadai. Multislice computed tomography (MSCT) coronary angiography is one of the latest usage area of the computed tomography technology. It s a non-invasive diagnostic tool, wich can be performed in ambulant patients. MSCT coronary angiography beside it's advantages has some drawbacks. The main drawbacks are lower spatial resolution and residual motion artifacts in MSCT images. Therefore quality of coronary images and diagnostic value of MSCT angiography differs, depending on patient's clinical characteristics, especially on heart contraction features during scanning. Asynchronic contraction and relaxation of the right and left ventricles, caused of bundle branch block can also influence image quality of MSCT coronary angiography. To date, there are only few studies, conducted to analyse diagnostic performance of MSCT coronary angiography in patients with left bundle branch block. Although influence of heart rate, heart rate variability and the other factors (for example, age, sex, body mass index) on MSCT image quality are quite well investigated. Thus, the present study were designed to investigate the influence of complete left bundle branch block on image quality of MSCT coronary angiography more detail in comparison with control patients group without electrical conduction disturbances, reveal the diagnostic value of MSCT angiography to identify hemodinamicaly significant coronary stenosis.

Multislice computed tomography (MSCT) coronary angiography is one of the latest usage area of the computed tomography technology. It s a non-invasive diagnostic tool, wich can be performed in ambulant patients. MSCT coronary angiography beside it's advantages has some drawbacks. The main drawbacks are lower spatial resolution and residual motion artifacts in MSCT images. Therefore quality of coronary images and diagnostic value of MSCT angiography differs, depending on patient's clinical characteristics, especially on heart contraction features during scanning. Asynchronic contraction and relaxation of the right and left ventricles, caused of bundle branch block can also influence image quality of MSCT coronary angiography. To date, there are only few studies, conducted to analyse diagnostic performance of MSCT coronary angiography in patients with left bundle branch block. Although influence of heart rate, heart rate variability and the other factors (for example, age, sex, body mass index) on MSCT image quality are quite well investigated. Thus, the present study were designed to investigate the influence of complete left bundle branch block on image quality of MSCT coronary angiography more detail in comparison with control patients group without electrical conduction disturbances, reveal the diagnostic value of MSCT angiography to identify hemodinamicaly significant coronary stenosis.

Prieširdžių virpėjimas (PV) dažniausiai klinikinėje praktikoje pasitaikanti širdies aritmija. PV dažnis populiacijoje – 0,4–1 proc. ir su amžiumi didėja, o tarp vyresnių nei 80 metų žmonių išauga iki 8 proc. Per pastaruosius 20 metų hospitalizavimo dėl PV atvejų padaugėjo 66 proc. PV metu išnyksta normali prieširdžių sistolė, vyksta prieširdžių remodeliavimasis, širdies ertmėse susidaro trombai, trinka hemodinamika. Tai susiję su sunkiomis komplikacijomis: širdies funkcijos nepakankamumu, insultu ir padidėjusiu mirštamumu. Veiksmingiausias PV nutraukimo būdas – elektrinė kardioversija, kuri klinikinėje praktikoje taikoma nuo 1962 m. Darbo tikslas – įvertinti prieširdžių virpėjimo gydymą elektrine kardioversija ir veiksnius, sąlygojančius jos efektyvumą. Darbo uždaviniai: 1. Nustatyti veiksnius, turinčius įtakos elektrinės kardioversijos efektyvumui. 2. Nustatyti ir įvertinti optimalią pradinio elektros impulso energiją, reikalingą prieširdžių virpėjimui nutraukti. 3. Nustatyti veiksnius, turinčius įtakos ankstyvajam prieširdžių virpėjimo atkryčiui po elektrinės kardioversijos. 4. Įvertinti veiksnius, nulemiančius elektrinės kardioversijos komplikacijas. Kauno medicinos universiteto Kardiologijos klinikos Kardiologijos intensyviosios terapijos skyriuje 2005–2007 m. atliktas prospektyvusis atsitiktinių imčių klinikinis tyrimas. Ištirta 224 prieširdžių virpėjimu sergančių pacientų, kuriems nuspręsta taikyti elektrinę kardioversiją sinusinio ritmo atkūrimui. Atsitiktinai... [toliau žr. visą tekstą] Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. AF occurs in 0.4 – 1 % of population and its frequency increases with age and reaches 8 % above 80 years age. During the last 20 years hospitalization for AF rate increased by 66 %. In AF normal atrial systole does not occur, atrial remodeling starts, intracardiac thrombi start forming, haemodynamics becomes compromised. That leads serious complications – heart failure, stroke and increased mortality rate. The most effective AF termination method is direct current cardioversion, which has been used in clinical practice since 1962. The aim of the study was to evaluate the treatment of atrial fibrillation by direct current cardioversion and to identify the factors, contributing to its effectiveness. The objectives of the study: 1. To identify the factors, contributing to the effectiveness of direct current cardioversion. 2. To estimate and to evaluate the optimal energy of the initial electrical impulse required to terminate atrial fibrillation. 3. To identify the factors, contributing to immediate recurrence of atrial fibrillation after successful direct current cardioversion. 4. To evaluate the factors, influencing complications after direct current cardioversion. A prospective randomized clinical trial has been held in Intensive Care Unit of the Department of Cardiology of Kaunas Medical University Hospital between 2005 and 2007. We examined 224 patients with AF, selected for electrical... [to full text]

The aim of the study To evaluate functional status changes, LV function and morphometry changes in patients with ischemic heart disease one year after LV volume reduction surgery of two different types. The objectives of the study 1.To evaluate clinical and functional status changes in patients one year after LV volume reduction surgery of two different types and to determine prognostic value of preoperative LV functional parameters affecting functional status changes in patients one year after surgery. 2.To evaluate LV function and morphometry changes one year after LV volume reduction surgery of two different types and to determine prognostic value of preoperative LV parameters for LV remodeling one year after surgery. 3.To compare LV function and morphometry changes in patients with anterior and posterior myocardial infarction one year after LV volume reduction surgery. 4.To evaluate the changes of mitral regurgitation grade and its relations with LV functional parameters one year after LV volume reduction surgery with or without concomitant MV repair. 5.To evaluate survival and its predictors one year after LV volume reduction surgery.

At present, cardiovascular diseases cause ca. 30 of deaths worldwide, and are the most common cause of death and disability (The World Health Report 2002; Pearson 1999). Coronary artery disease (CAD) accounts for nearly 50 of all deaths caused by cardiovascular diseases. In 2002, 7.2 million people died of CAD worldwide, and 5.8 million new cases were diagnosed. In 2000, the number of people with CAD around the world amounted to ca. 40 millions (Mackay 2004). The modern understanding of the pathophysiology of atherosclerosis and the concept of “cardiovascular risk factors” started forming in 1950s, when the first findings of the Framingham study were published (Wilson et al. 1998, D’Agostino et al. 2000). Information accumulated during scientific research on atherosclerosis allowed for a significant reduction of CAD-related mortality in the developed countries during the last 20 years, but a more profound analysis showed that the mortality mostly decreased in males, whereas in females it continues to grow. Nearly two-thirds of suddenly deceased women previously showed no clinical symptoms of CAD (AHA 2002). This most probably was influenced by a still predominant erroneous opinion that women, especially of younger age, very rarely have CAD and atherosclerosis of peripheral arteries. Epidemiological studies showed that cardiovascular diseases induced by atherosclerosis are equally frequent cause of death in both males and females. Of all patients who in 2000 in the U.S. died... [to full text]