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Unlabelled: Coronary artery disease (CAD) in women remains a difficult diagnostic problem. The usefulness of exercise electrocardiography (EXT) in these patients is limited. The value of other noninvasive tests including Tc99m-MIBI single photon emission computed tomography (SPECT), is still to be determined. Aim of the study was to assess the usefulness of Tc99m-MIBI SPECT in the diagnosis of CAD in women in comparison to EXT MATERIAL AND METHODS: 48 women age 38-64 years (mean 50 +/- 6) with symptoms of CAD were included to the study. EXT ECG and Tc99m-MIBI SPECT with dipyridamole were performed in all patients. The diagnostic value of the tests was assessed in comparison to coronary angiography. Sensivity, specifity and accuracy were calculated according to the generally accepted rules., Results: In 21 patients (44%) significant stenosis (> 50% diameter narrowing) in coronary angiography was found. In 18 (38%) of them single-vessel disease was detected. In 2 pts (4%) vasoconstriction was observed. EXT was positive in 28, negative in 17 and undiagnostic in 3 women with sensivity 72%, specificity 46% and an accuracy 58%. Perfusion defects were detected in 15 pts at rest and in 30 after dipyridamole infusion. MIBI SPECT had sensivity 91%, a specifity 60% and accuracy 74%. Evaluating tests enhanced sensivity to 100%, specifity to 71% and accuracy to 86%. SPECT sensivity was related to the localisation of coronary vessels changes: LAD 100%, Cx 66%, RCA 88% in case of single-vessel disease., Conclusion: Tc99m-MIBI SPECT proved to be a highly useful test in the diagnosis of CAD in women. Its diagnostic sensivity and accuracy is further enhanced by combination with ECG EXT. It has particular value in detection of one vessel disease.

Background: Sleep-related breathing disorders (SRBD) are the additional factor related to poor prognosis in patients with cardiovascular disorders. The apnoea/hypopnoea index (AHI), describing the number of apnoea and hypopnoea episodes per one hour of sleep, has been used as a marker of severity of the disorder. The disease is present in 4% of men and 2% of women above 40 years of age. However, SRBD are diagnosed in less than 3% of patients with this syndrome due to lack of awareness of the disease among health care practitioners and patients. Polysomnography (PSG) has been used as a golden standard for detecting SRBD, however this test is available only in selected centres. Therefore, a simple, fast and inexpensive test for screening for SRBD is necessary. Respiratory activity influences the amplitude of ECG signal whereas heart rate variability (HRV) depicts the activity of the autonomic nervous system. These associations have been used to develop a new method for detection of SRBD involving analysis of HRV and morphology of ECG signal in ECG monitoring., Aim: Assessment of accuracy of SRBD detection using estimated AHI (Est.AHI), calculated from Holter ECG recordings., Methods: In a study group consisting of 74 patients tested for SRBD, simultaneous PSG and 24-hour ECG monitoring were performed. Following PSG, AHI for each patient was calculated. According to the AHI values patients were classified as SRBD patients (AHI >15), non-SRBD patients (AHI <5), whereas 12 individuals had borderline SRBD (5< or = AHI < or =15). Age, prevalence of concomitant disorders and treatment were similar in all groups. In all individuals the Est.AHI value was calculated based on ECG recording. Considering the AHI value as a reference parameter discriminating SDB and non-SRBD patients, the number of false positive and false negative results for detecting SDB with the Est.AHI was calculated. Moreover, the SRBD detection accuracy using the Est.AHI calculation was evaluated by the receiver-operator characteristic (ROC) curves which were used to calculate area under curve (AUC), sensitivity, specificity, as well as positive (PPV) and negative (NPV) predictive values for optimal cut-off value., Results: According to Est.AHI, 50 (68%) patients were correctly diagnosed. The ROC analysis showed high accuracy of SRBD detection using Est.AHI: AUC - 0.91 with sensitivity - 91.2%, specificity - 87.5%, PPV - 88.6%, and NPV - 88.9%. The cut-off value of Est.AHI set at 17 was optimal for the differentiation between patients with or without SRBD., Conclusions: The Est.AHI calculated with the Lifescreen Apnea software from Holter ECG is an accurate, specific and sensitive method for the detection and classification of obstructive and mixed SRBD.

The aim of the study was to assess the effect of 1-year captopril therapy initiated 1-4 days (mean: 21-24 h) after beginning of AMI on exercise performance and myocardial ischemia during cycle ergometer test. 93 pts with first documented Q-wave AMI, aged L 70 years were qualified for the study. 50 of the pts were randomly included to the captopril group, 43 to the control group. In both groups pts with inferior AMI (accordingly 66% and 72%) and normal LV function (EF > or = 40% in ECHO) were prevailed in the study. Captopril therapy was initiated with the dose of 3.125 mg, then every 8 hours the dose of 6.25 mg was administered in Ist and IInd day, 12.5 mg--in III day and 25 mg from IV day on. Exercise cycle ergometer tests (ExT) were performed in every pt at 14 day, and 1, 3, 6 and 12 months after AMI. The ExT began at 25 W of power and was increased at 2-minute intervals by 25 W until fatigue or other typical cause of termination of the test. In the captopril group duration of ExT lengthened significantly in comparison with initial test (on 14 day) after 3 (6.4 +/- 1.47 vs 5.3 +/- 1.54 min; p < 0.01), 6 (6.7 +/- 1.59 vs 5.3 +/- 1.54 min; p < 0.001) and 12 months (7.0 +/- 1.22 vs 5.3 +/- 1.54 min; p < 0.001). In the control group exercise time was longer after 6 and 12 months compared to initial examination (accordingly 6.4 +/- 1.43 and 6.5 +/- 1.26 vs 4.8 +/- 1.47 min; p < 0.001). However, the differences regarding this time between the captopril and control group were not significant on consecutive control stages. The final result of the test (positive, negative, doubtful) did not differ significantly in both groups on consecutive examination stages. Captopril administered during 1-year period after AMI slightly improved physical working capacity (accelerated the improvement) and had no effect on ischemia during estimated cycle ergometer test. These results may depend on inclusion to the study predominantly pts with normal LV function and interior MI.

In 42 patients aged 33 to 79 years (mean age 55 years) with NYHA grade II chronic congestive circulatory failure, a comparative assessment was carried out of the effectiveness of treatment with captopril (29 patients, daily dose 18.75-150 mg, mean 82.5 mg) adn digoxin (13 patients, daily dose 0.125-0.5 mg, mean 0.275 mg). The patients were administered the drugs, depending on the improvement obtained, for 3-5 weeks. In the assessment of the effectiveness of the treatment, the following was taken into account: medical examination, laboratory investigations, chest X-ray, exercise tests and haemodynamic parameters measured during 2D and M echocardiographic examination. In the group of patients treated with digoxin the following was observed: a significant, in comparison to the patients receiving captopril, reduction of the heart rate by 11 beats per minute, decrease of the heart volume index by 50 ml/m2 and increase of the stroke volume by 14 ml. Higher effectiveness of captopril was observed as increase of the maximal workload during exercise test by 21 W and prolongation of its duration by three minutes. It seems that captopril may find use also in the treatment of early stages of circulatory failure.