Search

Background: The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE)., Aims: We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD)., Methods: We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2‑dimensional speckle‑tracking echocardiography, and twist was calculated as the difference between the basal and apical rotation., Results: Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge., Conclusions: During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.

Background: Whether non-invasive electrocardiographic parameters may be of similar relevance in pulmonary arterial hy-pertension (PAH) as in left ventricular heart failure (LVHF) remains unclear., Aim: To examine a profile of electrocardiographic parameters in PAH and to determine their prognostic significance. Com-parison of profile in patients with pulmonary hypertension secondary to left ventricular dysfunction was planned in order to put PAH group results into context., Methods: We included 41 patients with type 1.1/1.4.4 (according to the European Society of Cardiology) PAH and 31 patients with LVHF and type 2.1 pulmonary hypertension. All patients underwent 24-h ambulatory electrocardiography monitoring., Results: Among heart rate variability parameters, only RMSSD was different (mean, 75 ms [PAH] vs. 112 ms [LVHF], p = 0.016). In PAH, fewer patients had ventricular tachycardia (15% vs. 48%, p = 0.004), abnormal deceleration capacity (54% vs. 84%, p = 0.011), positive heart rate turbulence (11% vs. 48%, p = 0.003), severe autonomic failure (10% vs. 39%, p = 0.005), and ventricular late potentials (LP) (19% vs. 62%, p = 0.001). In PAH, four deaths occurred in 42 months. In univariate analysis, the risk factors for death were: LP (hazard ratio 13.55, 95% confidence interval 1.41-130.72; p = 0.024), age, N-terminal prohormone of B-type natriuretic peptide, while the protective factors were minimal and mean heart rate, as well as the six-minute walk test (6MWT) distance. In multivariate analysis, the influence of LP and the 6MWT distance remained significant., Conclusions: Ventricular LP were present in 19% of PAH patients and were the most powerful risk factor of mortality .

Background: Pulmonary arterial hypertension (PAH) is a rare disease with a very serious prognosis. It seems that mutations in genes related to transforming growth factor-b signalling pathway are often related to the development of the disease. No study covers this problem in a Polish population., Aim: To screen for genetic mutations in a Polish cohort of patients with pulmonary hypertension, especially with idiopathic PAH, treated in a single hospital in Poland., Methods: DNA sequencing method was used. Samples from 50 patients with pulmonary hypertension were screened for mutations in type 2 bone morphogenetic protein receptor of the transforming growth factor-b superfamily gene (BMPR2). Samples from 20 patients with idiopathic PAH (11 men, mean age 55 years) were also screened for mutations in activin A receptor-like type 1 gene (ALK1) and endoglin gene (ENG)., Results: No genetic variations were found for the BMPR2 gene. In all 20 samples from idiopathic pulmonary hypertension patients we found heterozygosity of single nucleotide polymorphism (SNP) rs 372023206 in ALK1 gene. Three samples from these patients showed variations of ENG gene: we found one sample with heterozygosity of SNP rs 200525684, one with heterozygosity of SNP rs 3739817, and one with both., Conclusions: We detected benign polymorphisms or genetic variants of unknown importance. It is possible that the Polish population of PAH patients differs from the previously described populations of other countries in terms of the frequency and importance of mutations in BMPR2, ALK1 and ENG genes.

We present the case of a woman treated with coronary angioplasty due to non-ST segment elevation myocardial infarction,then again because of restenosis, who continued to complain of chest pain and syncope. Holter electrocardiogram recording revealed atrioventricular block related to ST-segment elevations and variant angina was diagnosed. Despite administered medications, the patient required pacemaker implantation.

Background and Aim: We hypothesised that melatonin may represent a safe somniferous drug for cardiac patients, and assessed the effects of administering 5 mg of melatonin daily before bedtime for 30 days in patients with coronary artery disease (CAD) regarding changes in the nocturnal breathing pattern., Methods: Sixty patients with CAD (aged 48-80 years) were randomised to melatonin/placebo treatment in a 2:1 ratio. A Holter ECG-based method (Lifescreen Apnea software) which has been validated as a screening tool for sleep-disordered breathing was used to estimate the apnoea/hypopnoea index (AHI). A 24-h Holter ECG was used to detect nocturnal breathing abnormalities at the beginning and at the end of the observation. The values of estimated AHI (eAHI) ≤ 15 were classified as optimal (Opt) and those 〉 15 - as pathological (Pat). A change of the breathing pattern was classified on the basis of the transition between the initial and final eAHI status (Opt→Opt; Opt→Pat; Pat→Pat, Pat→Opt). The mean initial and final value of eAHI and the percent of Opt and Pat values of eAHI in the initial and final assessment were compared between the melatonin and the placebo groups., Results: The breathing pattern was not affected by melatonin - the mean initial value of the eAHI in the melatonin group was 18.2 ± 9.4, and in the placebo group 19.6 ± 12.3 (p = 0.64), whereas at the end of the observation in the melatonin group it increased by 1.2 ± 11.3, and in the placebo group - by 1.0 ± 9.0 (p = 0.44)., Conclusions: Hypnagogic treatment with melatonin did not worsen the eAHI in patients with CAD.

A 45 year-old woman was admitted to the hospital because of severe chest pain. Based on the results of troponin testing and ECG she was diagnosed as having acute coronary syndrome and was transferred to the cath lab. However, her coronary arteries were normal. In this paper a detailed analysis of the ECG was performed.

Background: Transplantation of bone marrow stem cells (BMSC) is a new method of prevention of left ventricular (LV) remodelling in post-infarction patients. Studies published to date point to LV systolic and diastolic function improvement following this therapy however only a few studies assessed the long-term effects of BMSC., Aim: To assess the 2 year prognosis in patients with anterior myocardial infarction (MI) treated with BMSC transplantation in the acute phase., Methods: The study group consisted of 60 patients with first anterior ST-segment elevation MI (STEMI), treated with primary percutaneous angioplasty, with baseline LV ejection fraction (LVEF) 〈 40%, who were randomly assigned to undergo BMSC transplantation on day 7 of the STEMI (40 patients, BMSC group) or to receive standard treatment (20 patients, control group). In all the patients echocardiography was performed at baseline and after 1, 3, 6, 12 and 24 months. The composite end-point (death, MI, admission for heart failure or repeat revascularisation) was assessed after 2 years of follow-up., Results: Absolute increase of LVEF compared to baseline values was higher in the BMSC group than in the control group. The LVEF increase in BMSC group at 1 month was 7.1% (95% CI 3.1-11.1%), at 6 months - 9.3% (95% CI 5.3-13.3%), at 12 months - 11.0% (95% CI 6.2-13.3%) and at 24 months - 10% (95% CI 7.2-12.1%). In the control group, LVEF increase was 3.7% (95% CI 2.3-9.7%) at 1 month, 4.7% (95% CI 1.2-10.6%) at 6 months, 4.8% (95% CI 1.5-11.0%) at 12 months and 4.7% (95% CI 1.4-10.7%) at 24 months. The composite end-point occurred significantly more frequently in the control group (55%) than in the BMSC group (23%): OR 2.72; 95% CI 1.06-7.02, p = 0.015., Conclusions: Treatment with mononuclear bone marrow cells on day 7 of the first anterior MI in patients with significant baseline systolic dysfunction improves 2-year outcome.

A 56 year-old woman with a transplanted heart, with arterial hypertension and chronic pulmonary obstructive disease, was hospitalised because of palpitations, dyspnea, chest pain and oedema. After cyclosporine treatment she was diagnosed with renal failure, which was treated by hemodialysis. Heart rate (HR) at admission was 100, mean HR in 24-hour Holter monitoring was 106 bpm. Ivabradine was added to the treatment. The dose of 2.5 mg bid was doubled after three days. Mean HR in control Holter monitoring was 81. Ivabradine was well tolerated in this patient. The clinical benefits were observed soon after application and maintained during the follow-up.

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.

Background: Pro-inflammatory cytokine interleukin-1b (IL-1b) plays a role in atherosclerosis. The results of several studies on the association between polymorphism of the IL-1b gene cluster and the course of coronary atherosclerosis have been inconclusive., Aim: To investigate retrospectively whether the patients with the most common variants of polymorphism of the IL-1b gene cluster differ with respect to localisation and extent of coronary atherosclerosis to a degree which may influence the treatment strategy., Methods: Ninety-two consecutive out-patients (age 39-83, male sex 74%) with coronary artery disease confirmed by angiography were included. In this group, 23 patients underwent coronary artery bypass grafting (CABG) and 69 percutaneous coronary interventions (PCI) of whom in 16 repeated treatment was performed. The polymorphisms of the IL-1b gene - transition C/T at -511 and -31 position - as well as of the IL-1 receptor antagonist gene (IL-1RN) - an 86-base pair variable-number tandem repeat in intron 2 - were determined by PCR. Out of the 54 theoretically possible combinations of polymorphisms, 17 were found in the studied group. The three most common combinations of polymorphisms were selected. The fraction of patients treated by means of primary or elective percutaneous coronary intervention (pPCI, ePCI) and by means of CABG were compared between the subgroups with one of the 3 most common combinations of polymorphisms., Results: The most frequent combinations of polymorphisms were - Variant A: -31 C/T, -511C/T, RN 1/1 - 32.6%; Variant B: -31T/T, -511C/C, RN 1/1 - 27.1%; Variant C: -31C/T, -11C/T, RN 1/2 - 10.8%. The remaining patients (29.5%) represented 14 variants present in very small subgroups consisting only of 1, 2 or 3 persons. Statistical analysis showed that patients with the second most common variant of studied polymorphisms (variant B) were significantly more frequently treated with CABG in comparison to the two other variants. Also, repeated PCI was most frequent in this subgroup., Conclusion: The data presented here suggest that carriers of the two relatively frequent variants of the IL-1b gene at -31 and -511 position, i.e. -31TT and -511CC, are at a higher risk of developing coronary artery disease requiring surgical treatment or two-stage percutaneous angioplasty.

Background: Heart rate turbulence (HRT) has been shown to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with chronic heart failure (CHF) has not yet been well established., Aim: To evaluate HRT in patients with CHF and assess the prognostic significance of HRT in this group., Methods: The study group consisted of 82 patients with CHF and left ventricular ejection fraction (LVEF) <35%. All the patients underwent 24-hour Holter monitoring (HM). The heart rate variability (HRV) and HRT parameters were assessed using HRT view software. Two HRT parameters - turbulence slope (TS) and turbulence onset (TO), were calculated. We analysed the clinical course and survival during a two-year follow-up (mean 25+/-9 months)., Results: The patients were divided into three groups according to the HRT parameters. Group 1 (23 patients) with both normal TO and TS (TO <0%, TS >2.5 m/s), group 2 (30 patients) with abnormal TO or TS, group 3 (29 patients) with abnormal TO and TS (TO >0% and TS <2.5 m/s). Patients from group 1 was significantly younger. There were no differences between patients in aetiology, treatment and the frequency of ventricular premature beats. Significant correlations between HRV and HRT parameters were observed. The correlation was the strongest between TS and SDNN and LF. During the follow-up 9 patients died and 15 were hospitalised for non-fatal infarction or worsening of CHF. Using a multivariate logistic regression model, it was shown that TS <2.5 ms/RR interval, and non-sustained ventricular tachycardia (VT) significantly increased the risk of a serious cardiac events in CHF patients., Conclusion: HRT parameters are often abnormal in patients with CHF. An abnormal turbulence slope (TS) and VT episodes are significantly associated with increased risk of cardiac complications in CHF.

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.

We present a case of a 78-year-old woman with severe valvular aortic stenosis which was diagnosed for the first time ever in our department despite the patient having been treated by general practitioners for several years because of diabetes mellitus. The patient complained of recurrent syncope, effort dyspnea and angina. During echocardiographic evaluation calcified stenotic aortic valve with extremely high maximal aortic gradient (199 mmHg) was found. The patient was qualified for surgical intervention. She died several hours after aortic valve replacement because of an acute aortic rupture and massive pericardial bleeding.

Background: A role of CD14 receptor in the inflammatory response is stimulation of monocytes and endothelial cells by lipopolysaccharide of Gram-negative bacteria. The reports about association of progression of atherosclerosis with CD14 gene polymorphism in different populations are conflicting., Aim: To assess if T to C exchange at position 159 of the CD14 gene correlates with age at the onset of first myocardial infarction (MI), severity of coronary atherosclerosis and number of risk factors in MI survivors in a local community characterised by high morbidity of cardiovascular diseases and whether this genotyping could be helpful in identifying patients with a high risk of MI at young age and beyond low number of risk factors., Methods: Fifty-seven MI survivors (75.5% males) from 98 consecutive patients (pts) with coronary artery disease were included. The genotypes in position 159 of the CD14 gene were determined by polymerase chain reaction. The medical history concerning diabetes mellitus, arterial hypertension, dyslipidaemia, smoking and obesity was taken from every participant. Gensini score (GS) was calculated on the basis of coronarography. Age at first MI, value of GS and number of risk factors were analysed variables. The pts were divided into the decades of life, according to cumulated number of risk factors and into the terciles according to GS. Distribution of ages at first MI, pts with different number of risk factors and percent of pts belonging to determined terciles of GS were compared between subgroups with genotype CC and CT, TT., Results: The CC genotype was detected in 25 (43.8%) pts, CT in 30 (52.6%) and TT in 2 (3.6%). Age at first MI ranged from 40 to 75 years, mean 58.7+/-7.23, values of GS ranged from 0 to 154, mean 48.6+/-25.7, and number of risk factors from 0 to 4, mean 1.92+/-0.99. No significant differences in distribution of ages at first MI, values of GS or number of risk factors were found between patients with CC and with CT or TT genotype in position 159 of CD14 receptor genotype., Conclusion: These data indicate that screening for CD14 159C/T polymorphism is unlikely to be a useful tool for risk assessment of MI at young age, independently of low number of risk factors, in a population with high morbidity from cardiovascular diseases.

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.

We present a case of 29-year-old male, with coronary artery disease in mother's history, after suicidal poisoning with 30 g of rifampicin, who presented severe chest pain, ST elevations in ECG, low values of blood pressure and elevated troponin I. Echocardiography revealed generalised hypokinesia, and depressed contractility--left ventricle ejection fraction was 7%. Urgent coronary angiography has shown normal epicardial arteries with slow contrast inflow. The toxic properties of rifampicin as well as hypotension due to dehydration are considered reasons of symptoms in the presented case.