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Background: The most important way to reduce the incidence of the atherosclerotic cardiovascular disease (CVD) is prevention, which should include modification of risk factors., Aim: To define knowledge of primary CVD prevention, and to rate compliance with prevention rules among students'., Material and Methods: The study included 275 first year (ly) students and 161 sixth year (6y) students of the Faculty of Medicine (303 Females and 133 Males; aged 18-29 years). Anonymous questionnaire on acquaintance with the primary prevention, compliance with it and correct values and units of blood pressure, blood glucose and cholesterol level was conducted among survey participants., Results: 6y students indicated risk factors of CVD significantly more correctly than ly students. The proper value of male and female waist circumference was indicated correctly more often by 6y students than ly students. When compared to ly students, 6y students more often marked properly the heart attack symptoms, tests which are necessary to diagnose ACS, and markers of the myocardial necrosis. Respectively, among the ly and 6y students the mean BMI was: 20.82 kg/m2 vs. 21, 74 kg/m2, mean waist circumference: 70.00 cm vs.74.81 cm. 6y students more often than ly students eat regular meals, eat fruits and vegetables more than 4 times a week, exercise more than 30 minutes a day., Conclusions: Sixth year medical students' knowledge about the prevention of CVD is greater than the first year students' but still is unsatisfactory. Sixth year students slightly often follow the rules of primary prevention than first year students.

Introduction: Tissue Doppler imaging (TDI) facilitates the quantitative assessment of the regional systolic and diastolic left ventricle function. Heart scintigraphy (SPECT) facilitates the assessment of regional perfusion of the myocardium. The aim of the study was the evaluation of the correlation between the regional myocardial perfusion defects observed in the SPECT study and the regional systolic and diastolic left ventricle function observed in TDI examination in the ischaemic heart disease patients., Material and Methods: In 40 patients (33 men and 7 women) aged 43-74 years (mean age 56 years) diagnosed of ischaemic heart disease on the basis of coronary angiography, rest TDI examination was performed. Maximal systolic and maximal early-diastolic myocardial velocities were assessed in 13 myocardial segments of the left ventricle, supplied by respective coronary arteries (left anterior descending artery--LAD, circumflex artery--Cx, right coronary artery--RCA). During rest and exercise perfusion scintigraphy of the heart (Tc99 MIBI SPECT) myocardial perfusion was evaluated in the segments analysed previously during TDI study. On the basis of the SPECT examination results the patients were divided into three groups: group I) patients with fixed perfusion defects, group II) patients with exercise-induced perfusion defects and normal rest perfusion, group III) patients with normal perfusion during rest and exercise., Results: Systolic and diastolic myocardial velocity in LAD and Cx supplied segments were significantly higher in group II and group III as compared with group I. Systolic and diastolic velocities of myocardium supplied by LAD were significantly lower in group II as compared with group III. In Cx supplied region the diastolic myocardial velocity was significantly lower in group II as compared with group Ill., Conclusions: In the left ventricle myocardial regions with fixed perfusion defects, statistically significant decrease of systolic and diastolic myocardial velocities was observed. Moreover, the decrease of diastolic myocardial velocity in the rest TDI examination was found in patients with normal rest perfusion and exercise-induced perfusion defects.

Unlabelled: Exercise intolerance is a major symptom in patients (pts) with congestive heart failure (CHF). A lack of correlation between the left ventricular systolic dysfunction and exercise capacity was found. Recently, it has been proposed that diastolic dysfunction may contribute to significant impairment of exercise tolerance in pts with CHF. The aim of the study was to compare the relationship between Doppler indices of diastolic function and exercise capacity in patients with CHF., Material and Methods: The study included 29 pts (20 M, 9 F) 14 with idiopathic and 15 with ischaemic cardiomyopathy. The mean left ventricular ejection fraction (LVEF) was 31 +/- 8%, VO2peak was 16.4 +/- 4.6 ml/kg/min. The mean age was 55.4 +/- 12.1, ranged from 30 to 73 years. All pts underwent complete echocardiography study. Diastolic performance was estimated using conventional Doppler mitral inflow (E, A) velocities, E/A ratio, deceleration time of E velocity (E-DT), isovolumetric relaxation time (IVRT) and color Doppler M-mode flow propagation velocity (Vp). Resting spirometry and cardiopulmonary exercise test (CPX) were performed in all pts. Exercise capacity was measured as oxygen consumption at peak exercise (VO2peak). The association between echocardiography parameters and VO2peak was evaluated by Spearman's correlation coefficients (r)., Results: We found that VO2peak correlated significantly with the LV filling pattern estimated by the transmitral Doppler E/A ratio (r=-0.4, p=0.03), A-wave velocity (r=0.4, p=0.03) and velocity flow propagation (r=0.4, p=0.05). There was no correlation between VO2peak and following mitral inflow parameters: (E-wave, DT, IVRT). There was no correlation between VO2peak and LVEF., Conclusions: 1. Doppler indices of diastolic function are important determinants of exercise capacity in CHF pts. 2. Assessment of transmitral flow velocities holds a substantial diagnostic potential, which may be utilized in everyday clinical practice as a alternative in routine monitoring of systolic heart failure.

Introduction: Percutaneous myocardial laser revascularisation (PMLR) has been developed for treatment of patients with refractory angina pectoris. This study was designed to evaluate long-term impact of PMLR on left ventricular systolic function., Material and Methods: Ten patients with refractory angina pectoris who underwent PMLR were studied with dobutamine stress echocardiography before procedure, at early follow-up after 1-3 months and at long-term follow-up after 2-3 years post procedure. Wall motion score index (WMSI) and ejection fraction (EF) were calculated at rest as well during infusion of dobutamine with low and high rate., Results: Mean WMSI at rest decreased significantly from 1.71 +/- 0.24 before PMLR to 1.55 +/- 0.21 at early follow-up (p=0.0189) and 1.48 +/- 0.26 (p=0.009) at long-term follow-up. Mean WMSI during low-rate dobutamine infusion decreased significantly from 1.39 +/- 0.29 to 1.25 +/- 0.25 (p=0.0276) at early follow-up, but was not significantly different in long-term. Mean WMSI during high-rate dobutamine infusion decreased significantly from 1.83 +/- 0.21 before PMLR to 1.56 +/- 0.2 at early follow-up and 1.57 +/- 0.29 (p<0.03) at long-term evaluation. Mean EF at rest increased significantly from 48 +/- 8.6% before PMLR to 56.9 +/- 7.9% (p=0.0189) at early follow-up. At long-term follow-up mean EF at rest was 52.7 +/- 8.3% and was not significantly different from baseline. Mean EF during low-rate dobutamine infusion was not significantly different from baseline both at early and long-term follow-up. Mean EF during high-rate dobutamine infusion increased significantly from 44.5 +/- 8.6% before PMLR to 58.1 +/- 7.0% (p=0.0093) at early follow-up while in long-term it was 51.3 +/- 9.8%, which was not significantly different from baseline. These changes were accompanied by significant decrease of mean CCS score from 3.52 +/- 0.51 before procedure to 2.54 +/- 0.78 (p<0.0001) after 1 month and 2.78 +/- 0.65 after 24 months., Conclusions: In patients with refractory angina pectoris treated with PMLR significant early improvement of systolic left-ventricular function is observed with trend toward improvement in long-term. It is accompanied with significant long-term angina relief.

Background: Congestive heart failure is associated with the increase risk of death or cardiac transplantation. The ability of current techniques to predict outcome in heart failure is rather limited. Identification of the patients at risk of cardiac death or requiring heart transplantation is clinically important. The changing rate of left ventricular pressure during the cardiac cycle is an important parameter in the assessment of myocardial systolic function. Non-invasive echocardiographic method--dP/dt has been proposed to determine the isovolumic phase of cardiac function. The aim of this study was to evaluate the ability of Doppler-derived dP/dt to predict survival in patients with congestive heart failure., Material and Methods: Thirty one patients (22M, 9W), mean age 55 +/- 11.2 years, with CHF (LVEF < 45%, NYHA II-IV class) and chronic mitral regurgitation were analyzed. The echocardiography, cardiopulmonary exercise test and clinical follow-up were performed in all of them. The ejection fraction was calculated using the Simpson's method from apical 4-chamber view. The dP/dt index was derived from the continuous-wave Doppler spectrum. The mean follow-up period was 28.5 +/- 12 months. According to the clinical status the patients were divided into two groups: group I--21 event-free patients and group II--10 patients who experienced primary events (5 died and 5 underwent heart transplantation)., Results: In the group of primary events patients there was noted a significant decrease of the dP/dt index in comparison to the event-free patients: 463 mmHg/s vs 839 mmHg/s (p=0.0001). The correlation between dP/dt and ejection fraction, left ventricular end-diastolic diameter as well as between the parameters of cardiopulmonary exercise test VO2peak, VO2AT, VE/VCO2peak was found., Conclusions: Doppler echocardiographic index of dP/dt can predict the outcome in patients with congestive heart failure. Dp/dt can be useful as a prognostic factor in patients with CHF. A significant correlation was observed between dP/dt and VO2peak as well as VE/VCO2peak which are independent prognostic predictors.

This case study presents two patients with aortic stenosis and infective endocarditis (IE) who underwent homograft aortic valve replacement. The first patient is a 67 year old practicing surgeon. Twenty one years ago, he was admitted to our department for critical aortic stenosis, infective endocarditis (IE) and heart failure. He underwent homograft aortic valve replacement. After the surgery his condition improved dramatically and he returned to his practice. Current echocardiographic study shows normal function of the left ventricle and normal gradient across homograft aortic valve. The next case, a 33-year old happy mother of 5 children, is particularly interesting. When she was 15 years old, she was referred to surgery, diagnosed with bicuspid aortic valve stenosis, subaortic muscular stenosis and aneurysm of aortic sinus of Valsalva. She underwent homograft aortic valve and root replacement and excision of the sub-aortic muscle bulge. Eleven months later, she required another operation due to active IE. The St. Jude Medical aortic valve was implanted. Two months after the surgery a dysfunction of the implanted artificial valve was diagnosed. She again underwent the homograft aortic valve and root replacement with good long-term results. In the period spanning 1987-1997, she managed to deliver five babies without any complications whatsoever. Seventeen years later, the homograft aortic valve is still functioning fairly well. The homograft aortic valve replacement may be regarded as a viable option for patients with aortic stenosis and IE and for young women suffering from aortic valve disease who intend to be prospective mothers.

A 58-year-old woman with symptoms of angina underwent coronary angioplasty, which showed critical narrowing of the right coronary artery (80%) and borderline narrowing of the left anterior descending coronary artery (50%). We decided to analyse myocardial perfusion in this patient to estimate the degree of atherosclerosis in the target arteries. She underwent myocardial contrast echocardiography at rest and during dobutamine stress. The examination showed a transient perfusion defect in the right coronary bed and in the left anterior descending coronary. A similar perfusion defect was revealed in scintigraphy. We carried out a successful two vessel percutaneous coronary revascularisation.

Myocardial contrast echocardiography is a non-invasive method used to detect coronary artery disease. It was first described in 1968. New contrast agents which can go through the pulmonary vessels were discovered in the last years. Contrast echocardiography is useful in improving the endocardial border delineation and left ventricular cavity visualisation especially in patients with suboptimal acoustic windows. As the contrast passes further into the coronary artery normal myocardium perfusion is enhanced while ischaemic areas lack enhancement. Analysis of perfusion allows indirect identification of narrowed coronary arteries. Left ventricular function and its myocardium perfusion are made with contrast echocardiography at rest and during pharmacological stress tests. These examinations allow for detection patient with coronary artery disease as well as estimating efficacy of revascularisation procedures.

Unlabelled: The aim of the study was to determine the degree of reproducibility of parameters of cardiopulmonary exercise (CPX) tests in patients with chronic heart failure (HF)., Material and Methods: We investigated 30 patients (7 women, 23 men) with ages ranging from 44 to 68 and a mean age of 56 +/- 14.5 years with HF due to dilated cardiomyopathy (5 patients) and coronary artery diseases (25 patients). The mean ejection fraction was 24 +/- 6.2%. All the patients were symptomatically stable during the preceding 4 weeks. After a preliminary test, the patients underwent two treadmill CPX tests using modified Naughton protocol with a 1-week interval between tests. CPX tests were performed at the same time of the day, using the same equipment and the patients were receiving constant medication. The reproducibility was assessed for: Rest heart rate (HRrest), oxygen uptake at the anaerobic threshold (VO2AT) and peak exercise (VO2peak), carbon dioxide production (VCO2peak), ventilatory equivalent of carbon dioxide (VE/VCO2peak) and oxygen (VE/VO2peak), end-tidal partial pressure for carbon dioxide (PETCO2peak), exercise time (T) and respiratory exchange ratio (RER)., Results: The reproducibility was found for all analyzed parameters of CPX tests: HRpeak (p < 0.0001), VO2AT (p < 0.0001), T (p < 0.001), HRpeak (p < 0.0001), VO2peak (p < 0.0001), VO2peak%N (p < 0.0001), VE/VCO2peak (p < 0.0001), VE/VO2peak (p < 0.0001), PETCO2peak (p < 0.0001), RER (p < 0.004)., Conclusion: On adherence to standardized conditions, an excellent reproducibility exists for the most important parameters of cardiopulmonary exercise tests. CPX tests provide a useful and objective method of assessing functional capacity and diseases progression in patients with heart failure.

Unlabelled: Decreased heart rate variability (HRV) is an independent risk factor for sudden cardiac death in patients with coronary artery disease (CAD) and previous myocardial infarction. The influence of myocardial revascularization on HRV parameters has been investigated for the past few years. However, little is known about HRV behaviour in patients with CAD treated with percutaneous transluminal coronary angioplasty (PTCA). The purpose of this study was to estimate HRV parameters before PTCA and during a one year follow-up. We examined 65 patients (47 men, 18 women; mean age 51.2 +/- 7.6), who underwent successful and uncomplicated PTCA. Thirty eight patients had a prior myocardial infarction. The mean left ventricular ejection fraction was 59.8 +/- 8.1%. Thirty-nine patients had a single-vessel disease, 25 patients had a double-vessel disease and one patient had a triple-vessel disease. Serial 24-hour Holter monitoring (before PTCA, 14 days, 3, 6, 12 months after PTCA) was performed in all patients. The following time domain measures of HRV were calculated from each recording, for 24-hours: pNN50, SDNN, SDANN and rMSSD. During the one year follow-up, a significant increase of pNN50, SDNN and SDANN was observed. We noted, that the statistically significant increase of the above-mentioned parameters occurred during the first 3 month follow-up. The results of the next serial recordings (6 and 12 months after PTCA) demonstrated no additional changes in HRV values, however they were still significantly higher than before procedure. Mean values of HRV parameters before PTCA and 3 months after were as follows: pNN50: 8.8 +/- 6.8%, vs 11.7 +/- 9.4% (p < 0.05), SDNN: 121.2 +/- 33.5 ms vs 148.2 +/- 29.3 ms (p < 0.05), SDANN: 113.6 +/- 16.2 ms vs 125.1 +/- 22.3 ms (p < 0.05). Parameter rMSSD did not change significantly during the whole observation., Conclusions: 1. Myocardial revascularisation with successful PTCA leads to an improvement in the autonomic modulation of heart rate. 2. The increase in parasympathetic control of the heart rate is already being observed 2 weeks after successful PTCA. 3. Beneficial increased influence of both parts of the autonomic nervous system on heart rate persists for 12 months after coronary angioplasty.

Unlabelled: The objective of this study was to assess the ventilatory parameters of cardiopulmonary exercise test (CPX) in patients with moderate and severe heart failure (HF)., Material and Methods: We investigated 110 patients (pts) (mean age 52.1 +/- 11.1 years) with chronic HF due to dilated cardiomyopathy (42 pts) or coronary artery disease (68 pts). Resting spiro-metry, CPX on a treadmill (modified Naughton protocol, 83 pts, or modified Bruce protocol, 26 pts) and echocardiography were performed. The following parameters were analyzed: left ventricle ejection fraction (EF), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Both FEV1 and FVC are expressed as a percentage of predicted normal values (FEV1-%N, FVC-%N), FEV1/FVC ratio, rest and peak parameters of CPX ratio of physiological dead space to tidal volume (VD/VTrest, VD/VTpeak), respiratory rate (RRrest, RRpeak), minute ventilation (VErest, VEpeak), tidal volume (VTrest, VTpeak), endtidal Pco2 (PETCO2rest, PETCO2peak), endtidal Po2 (PETO2rest, PETO2peak), ventilatory equivalent for carbon dioxide (VE/VCO2rest, VE/VCO2peak) and oxygen (VE/VO2rest' VE/VO2peak), exercise time (T), peak oxygen uptake VO2peak' VO2peak%N, heart rate reserve HRR, peak heart rate HRpeak%N. After the mean follow-up period of 28.5 +/- 12 months, the patients were divided into groups: Group I: n = 78 pts who survived without heart transplantation (HTX) and Group II: n = 32 pts; n = 20 pts who died while on the transplant list; n = 12 pts who underwent urgent HTX., Results: The patients in the group II had lower EF, more reduced peak oxygen consumption and shorter duration of exercise. We found that FEV1, FVC, FEV1-%N, FVC-%N were more severely impaired in group II. The patients in group II also had lower PETCO2rest and higher PETO2rest. There were no differences in the FEV1/FVC ratio, VD/VTrest, RRrest, VTrest, VErest, VE/VCO2rest, VE/VO2rest between the groups. The value of VD/VTpeak, VE/VCO2peak, VE/VO2peak, PETCO2peak were significantly higher in group II when compared with group I, but the values of PETO2 were lower. Despite a shorter duration of CPX in group II there were no differences in HRpeak%N, HRR, RRpeak, VTpeak, or VEpeak, between the groups., Conclusion: At rest the patients with more severe HF appear to have a more restrictive pulmonary pattern and impaired pulmonary gas exchange. During exercise, the patients with severe HF have an increased dead space in the lung; more impaired pulmonary gas exchange and increased ventilatory response at a given workload.

Unlabelled: The aim of this study was to compare echocardiographic assessment of the severity of mitral regurgitation (MR) with angiographic grading., Material: 51 patients (patients) with MR (43 men and 8 women), aged from 38 to 75 (mean 56 +/- 9 years), were used in the study. The etiology of MR was: Coronary artery disease (28 pts), infective endocarditis (3 patients), rheumatic disease (5 patients), dilated cardiomyopathy (7 patients), mitral valve prolapse (8 patients)., Exclusion Criteria: Aortic stenosis and/or aortic insufficiency, mitral stenosis, mechanical prostheses and atrial fibrillation., Methods: The mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were estimated by the proximal convergence method (PISA), regurgitant fraction (RF) and vena contracta width (VCW) by color Doppler quantitative method and compared to the cine ventriculographic grades. The angio-graphic severity of MR was classified as 1 to 4 grades according to the Sellers criteria., Results: There was a good correlation between the angiographic grading and ERO (r = 0.855, p < 0.001), RV (r = 0.868, p < 0.001), RF (r = 0.923, p < 0.001) and VCW (r = 0.846, p < 0.001)., Conclusions: 1. PISA method is clinically useful in routine evaluation of the severity of MR. 2. VCW provides a simple method for the identification of patients with severe MR. 3. These methods offer an alternative approach in quantifying MR noninvasively.

Restenosis at dilatation site still constitutes a significant limitation of percutaneous coronary revascularisation. Majority of patients with restenosis are treated with repeat angioplasty, although its impact on long-term outcome is still little known > Very few studies focused on this issue bring rather discrepant results. The present study is aimed at assessing the impact of restenosis on long-term outcome in patients treated with coronary angioplasty. A group of 567 patients, who in the years 1987-1996 had successfully undergone percutaneous balloon coronary angio-plasty (PTCA) at our Clinic, was retrospectively divided into two groups: a group comprising 188 patients (33.2%) suffering from recurrent angina in whom restenosis had been established through control angiography, and a group comprising 379 patients (66.8%) who during the observation period exhibited no angina symptoms, or in whom the control angiography did not reveal restenosis. The restenotic patients were older (p = 0.007), more frequently exhibited symptoms of unstable angina upon PTCA (p < 0.0001), and there were also fewer smokers among them (p = 0.02). Furthermore, restenotic patients more frequently had multivessel and multilesion angioplasty (p = 0.025; p = 0.004, respectively). Restenosis after the first PTCA was treated by repeated angioplasty in 149 (79.3%) patients, 26 (13.8%) underwent CABG operation and 13 (6.9%) patients were treated pharmacologically without repeated revascularization. Within the 5-year observation period the mortality rate in both groups did not differ significantly (5.9% vs. 4.0%). Restenotic patients sustained myocardial infarctions more frequently (8.0% vs. 3.2%, p = 0.01), had significant atherosclerosis progression (37.2% vs. 15.0%, p < 0.0001), and were more frequently subjected to repeated interventions (37.2% vs. 15.0%, p < 0.0001), both PTCA (79.3% vs. 11.6% p < 0.0001) and CABG surgery (32.5% vs. 4.2%, p < 0.0001), as well as to multiple re-interventions (31.9% vs. 4.8%, p < 0.0001), in comparison with the non-restenotic ones. Analysis of functional status of patients assessed in compliance with the CCS criteria at the end of the observation period proved that significantly more non-restenotic patients did not experience angina, or experienced it rather sporadically (CCS Class 0 and 1). Logistic regression uni- and multivariate analysis proved that restenosis is an independent risk factor of myocardial infarction, reinterventions--also multiple ones--and cardiac events, although not mortality.

Unlabelled: The aim of the present study was to examine the effect of exercise test on QT dispersion (dQT) and to compare the result in women with syndrome X with women with coronary artery disease and normal subjects. We examined 53 women in mean age 54.2 +/- 9.2 who were divided into groups: 20 women with one-vessel coronary artery disease (group I), 19 women with syndrome X (group II) and 14 healthy control women (group III). All subjects underwent a modified Bruce protocol exercise test and QT intervals were measured manually at rest and peak exercise. The value of dQT was calculated as a difference between the longest and the shortest measured value in each of the 12 ECG leads. Corrected QT (dQTc) dispersion was measured after the QT interval was corrected with Bazett's formula. There were no significant differences in rest values of dQT between groups but rest dQTc was significantly greater in group I and II then in group III. We observed significant increase in dQT and dQTc on peak exercise in group I and II when compared with group III., Conclusion: At rest dQTc is significantly greater in women with syndrome X and coronary artery diseases in comparison with control subjects. The exercise caused increase in the value of dQT and dQTc both in women with syndrome X and coronary artery disease. The value of dQT and dQTc makes impossible to differentiate between women with syndrome X and women with coronary artery disease.

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

In this study the group of 30 patients with coronary artery disease (mean age 55 +/- 7 years) were examined. All patients underwent repeated percutaneous transluminal coronary revascularisation (rePTCR) due to coronary artery restenosis after primary coronary angioplasty. QT dispersion (dQT) and the corrected QT dispersion (dQTc), obtained applying Bazett's (dQTB) and Hodge's (dQTH) formulas, were measured before rePTCR and 7 days after rePTCR. Standard 12-lead electrocardiograms, 25 mm/s speed, were used. QT dispersion, defined as a difference between maximal and minimal QT intervals, was manually measured. The significant decrease of dQT after rePTCA was observed. Mean dQT before rePTCR was 88.67 +/- 29.09 ms and 64.00 +/- 28.96 ms after rePTCR (p < 0.0001). The changes of dQTc (dQTB, dQTH) were similar. Mean values of dQTB before and after rePTCR were 92.97 +/- 34.40 ms and 65.42 +/- 29.80 ms respectively, and mean values of dQTH were 94.90 ms +/- 37.31 ms and 70.98 ms +/- 32.85 ms. It was also noted that the frequency of appearance of dQT exceeding 80 ms significantly decreased after rePTCR (dQT exceeded 80 ms in 17 cases before rePTCR vs 5 cases after revascularisation). Increased QT dispersion can be a marker of the coronary artery restenosis.

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.

Unlabelled: Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006)., Conclusions: Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.

We present patient with the Marfan syndrome in whom the dissecting abdominal aortic aneurysm comprising the left iliac and femoral artery was diagnosed two years after the implantation of an artificial aortic valve. The chest CT showed the extention of the ascending aorta without the aortic dissection features. The patient was taken into the clinic in a very bad general condition with sinus tachycardia, the left ventricular failure together with pulse absence in all standard places of pulse measurement in the left lower limb. During the TEE examination the dissecting aneurysm of type I according to De Bakey's classification and the normal function of the artificial aortic valve were recognized. Colour Doppler revealed the primary entry site above the sinus of Valsalva. The patient was qualified for an urgent surgical intervention. The diagnosis was confirmed during the operation. The patient had resection of aneurysm with Dacron tube replacement. After the cardiosurgical intervention the ischaemic symptoms of the left lower limb retreated, the size of the heart diminished in the chest X-ray and TTE examination. The left ventricular ejection fraction increased from 45% to 62%. The TEE of the patient proved the most accurate and precise method of the diagnosis of the aortic dissection. The obtained information was sufficient to decide on the surgical intervention.

Restenosis occurs to be an Achilles heel of coronary interventions. Three overlapping processes: elastic recoil, neointimal proliferation and arterial remodelling are responsible for development of arterial renarrowing. The only method which proved efficient in reducing the restenosis rate is coronary stenting. Stents deployed using high pressure technique diminish restenosis rate by about one third. Stents eliminate elastic recoil and arterial remodelling but aggravate neointimal proliferation. A concept of radiation therapy was introduced to solve the problem of neointimal hyperplasia. Experiments on animal models of restenosis proved that both gamma as well as beta irradiation inhibited neointimal proliferation after arterial injury. Results of experimental investigations concerning both intraarterial irradiation during angioplasty as well as radioactive stent implantation are reviewed. Authors discuss also results of first clinical trials, the design and preliminary results of some larger studies like PARIS, SCRIPPS, GENEVA, BERT, IRIS, WRIST. Further investigational directions in intravascular radiation therapy are also presented.

The purpose of the study was to compare the antianginal and hypotensive efficacy and tolerability of 8 weeks of treatment with amlodipine taken once daily and nifedipine taken twice daily in patients with stable exertional angina pectoris and mild-to-moderate hypertension. Following a 2-week placebo run-in-period 13 patients were randomized to receive amlodipine (5 to 10 mg once daily) and 8 patients to receive nifedipine (20 or 40 mg twice daily) in an 8-week treatment phase. Antianginal efficacy was assessed with angina diares, investigators, and patients global evaluations and with treadmill exercise test during placebo run-in-period and after 8 weeks of the therapy. Amlodipine significantly reduced both weekly anginal attacks and consumption of glyceryl trinitrate tablets. This effect was more pronounced compared to efficacy of nifedipine. Exercise tolerance was also improved more markedly after amlodipine than after nifedipine treatment. Amlodipine treatment resulted in significant increase in total exercise time, increase the exercise time to angina onset, increase time to ST segment depression, decrease in ST segment depression, decrease in total duration of ST segment depression and decrease in duration of pain. In patients treated with nifedipine only favourable effect was significant decrease in total duration of ST segment depression, without significant changes of other examined parameters. Both drugs decreased blood pressure with no significant change in heart rate. No serious adverse events occurred in any patients during therapy with amlodipine as well as with nifedipine. The results of the study demonstrate that amlodipine has markedly better anti-anginal efficacy than nifedipine with respect to the most of the parameters examined. However both drugs showed comparable antihypertensive action and both were well tolerated by angina patients. The good anti-anginal and hypotensive efficacy and safety of amiodipine with once daily dosage regimen makes this drug an excellent choice of treatment for hypertensive patients with severe coronary artery disease.

Dilated cardiomyopathy (DC) and myocarditis (MCD) are still cardiac diseases of unknown etiology and pathogenesis. Due to uncertain natural history of MCD also treatment remains controversial. We observe long-term outcome of 30 pts with biopsy-proved MCD (group I) and 25 pts with DC (group II). The diagnosis of MCD was established on Dallas criteria of MCD. Almost all pts presented symptoms of congestive heart failure. All group I pts were treated with immunosuppressive agents: azathioprine 1.5 mg/kg/d and prednisone with initial dose of 1.5 mg/kg/d. After tapering off 0.75 mg/kg/d of prednisone and initial dose of azathioprine were given up to 6 months. All pts obtained digitalis, diuretics, ACEI, antiarrhythmic drugs if necessary. We studied the survival and clinical status (NYHA class) of treated pts. Clinical improvement was observed in 93% of pts with MCD within 6 months, but 20% of pts deteriorated within the next 6 months. Almost all pts survived 1 year. Out of 30 pts with MCD, 16 pts remain in lower NYHA class (NYHA I-II) between 26 and 69 months of follow-up. Within the group II (DC) 28% of pts died in the first year of observation. Out of 15 pts in 14 pts advanced chronic heart failure (NYHA III-IV) is presented in the end of observation. Echocardiographic parameters of pts with congestive heart failure and biopsy-proved MCD or DC did not differ significantly. We observed correlation between improvement of the LV echocardiographic parameters and improvement of clinical status of treated pts.