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Introduction: Increased values ofnatriuretic peptides are considered prognostically significant in normal population with respect to mortality and the incidence of cardiovascular events, regardless of the left ventricular function. The objective of the study is to point out the factors related to NT-proBNP values in patients without the heart failure syndrome and with normal left ventricular systolic function., Methods: The group consisted of 290 elective patients aged between 50 and 82, with the mean age of 62 years, of whom 47% were women. The enrolled patients were heamodynamically stable, without a history of MI, with a normal left ventricular systolic function and with the serum creatinine level < 150 micromol/l. On the same day, the following procedures were performed: left heart catheterisation, NT-proBNP sampling and echocardiographic examination. Diabetes mellitus, hypertension, coronary heart disease, body mass index, age, sex, left ventricular end-diastolic pressure and aortic pulse pressure were chosen as factors with possible impact on the level of NT-proBNP. We used echo parametres to assess the size of the left ventricle, the left ventricular mass index and the presence of left ventricular diastolic function., Results: The median of NT-proBNP was 110 pg/ml (min. 11; max. 1,943 pg/ml), and higher values were recorded for 116 (i.e. 40%) of the total number of patients. Based on the above-referred factors, a significant relation was demonstrated between NT-proBNP and age (p < 0.01), sex (p < .01), BMI (p = 0.03), left ventricular size (p = 0.02), left ventricular mass index (p = 0.01), and aortic pulse pressure (p < 0.01)., Conclusion: The study has shown that the level of NT-proBNP in patients does not solely depend on the haemodynamic status and left ventricular function, but is related to many other risk factors of cardiovascular mortality and morbidity.

Introduction: The percentage of older population has significantly increased in the recent decades. Morphologic and functional changes of the cardiovascular system go together with ageing. The aim of the study should show the correlation between the age and left ventricular enddiastolic pressure (LVDEP) value., Methods: 106 patients of the age from 23 to 79 years without an organic heart disease and the history of hypertension underwent elective coronary angiography including left ventricle angiography between 1999 and 2002. LVEDP was obtained as an average value from 8 consecutive beats without extrasystoles. According to the relation between increased relative frequency of LVEDP and age patients were divided into two groups: 50 years and older (80 patients) and younger than 50 years (26 patients)., Results: An average LVEDP value in older population versus younger population was 12.1 +/- 5.0 mm Hg vs 8.9 +/- 3.4 mm Hg, p < 0.05. Increased LVEDP in yonger population was found in only 11.5 % vs 46.2 % in older group, p < 0.01 and the LVEDP was age dependent, p < 0.05., Conclusions: In compliance with about mentioned results we suppose that the age is a factor with impact to LVEDP value. LVEDP values > 12 mm Hg in older population may not be pathological and probably are due to the left ventricle diastolic dysfunction in consequence with ageing.

Background: The primary success of the coronary artery reperfusion by primary coronary intervention (PCI) is almost angiographically assessed by TIMI flow score. The perfusion at a microvascular level can be inadequate despite the restoring of normal flow in the epicardial coronary artery. One of the options of successful reperfusion at a microvascular level is the measurement of ST-segment resolution (STR) after primary PCI., Aim: The assessment of ST-segment resolution in patients indicated for primary PCI and the comparison with clinical data., Methods: The authors studied 149 patients (68.5 % men) with ST elevation acute myocardial infarction treated by primary PCI. The ECG was taken at the time of arriving patient at coronary unit and compared with ECG early after primary PCI. Patients were divided into 3 groups according to the grade of STR: with complete (> or = 70%), partial (30-69%) and none (< 30%) STR. The lead with maximal changes (STEmax) and sum of ST elevation (STEsum) were assessed., Results: 42 (28.2 %) patients had complete STR, 55 (36.9%) partial STR and 52 (34.9%) patients didn't achieve STR. STR was connected with better left ventricular ejection fraction, which was in group with complete STR 50% compared with 39.4% in group without STR (p < 0.0001). Patients with symptoms of heart failure on admission (Killip II-IV) had complete STR only in 4 cases (10%) compared with patients without heart failure (Killip I), where was complete STR in 38 (34.8%), (p = 0.003). There wasn't noted significant difference in STR at dependence on glycoprotein IIb/IIIa inhibitors administration. A normal or mildly slower coronary flow (TIMI 2, 3) was achieved in 146 patients (98%), 3 patients (2%) had inadequate coronary flow after primary PCI (TIMI 0, 1)., Conclusions: The evaluation of early ECG changes is simple method for the assessment of primary PCI success at the microvascular level. Our outcomes confirm a differences in achievement of optimal epicardial coronary flow and a perfusion at microvascular level.

Background: Primary coronary angioplasty was accepted as a method of choice in the reperfusion treating strategy of the ST elevation acute myocardial infarction. Since 1995, when the very good results of the stent implantation in patients with acute myocardial infarction were published, there has been a general trend to more stenting also in the Czech Republic., Aim: The analysis of the effectivety and safety of the coronary stent implantation in acute myocardial infarction., Methods: Prospective analysis of the patients with ST elevation acute myocardial infarction treated with primary coronary angioplasty with one coronary stent implantation at least in the period I/2000-XII/2000., Results: In the above mentioned period the authors carried out the total of 116 primary coronary angioplasties in 116 patients with ST elevation acute myocardial infarction. Balloon angioplasty only was done in 27 patients (23.3%) only, at least one stent was implanted in 89 patients (76.7%). The average procedure time was 58 +/- 27.2 mins, fluoroscopy 10.6 +/- 6.6 mins, sciagraphy 1.8 +/- 0.7 mins. Primary angiographical result was optimal in 82 cases (92.2%) with achieving TIMI flow 3, in 5 cases (5.6%) there was slower perfusion of the infarcted artery observed with TIMI flow 2 and in 2 cases (2.2%) the authors were unsuccessful with final TIMI flow 0-1. Coronary stents were implanted in 13 cases (13.8%) without predilatation as so called "direct stenting", in 19 cases (20.2%) the planned or "elective" stenting was done, in 47 cases (50%) the suboptimal result after balloon angioplasty only was the reason for stent implantation and in 15 cases (16%) it was rescue "bail-out" stenting in complications of the balloon angioplasty only or if the result after balloon angioplasty was unsuccessful. Primary angiographical success of the stented lesion was 100% and in 14 cases (15.7%) the abciximab as a representative of IIb/IIIa platelet blockers was given. Periprocedural complications (up-to 24 hours after the procedure) in the stented group of patients occurred in 2 cases (2.2%), further serious in-hospital cardiovascular complications occurred in another 4 cases (4.4%). The total of 5 patients (5.5%) died in the hospital, out of which 4 patients (4.4%) died due to the primary cardiogennic shock and 1 patient (1.1%) admitted in pulmonary oedema died due to the heart failure progression. Excluding patients primary in cardiogennic shock the in-hospital mortality was 1.2% only. Hospital mortality in the group of patients treated with primary balloon angioplasty only was 3.7% (1 patient)., Conclusion: At present the coronary artery stenting is safe and highly effective method in acute myocardial infarction treatment.

Background: Primary coronary angioplasty is at present accepted as the most effective reperfusion treatment strategy of the ST elevation acute myocardial infarction. The optimum approach appears to be combination of the interventional technique (mechanical reperfusion) with aggressive pharmacological treatment aimed at the platelets. Intravenous blockers of the glycoprotein receptors IIb/IIIa together with acetylsalicylic acid have the additive antiaggregant effect and are used more frequently as adjunctive therapy by coronary interventions in patients with acute coronary syndromes and the acute myocardial infarction., Aim: The assessment of safety and effectiveness of the IIb/IIIa platelet blockers in patients indicated to primary coronary angioplasty., Methods: Since 1st January 2000 to 30th June 2001 the authors carried out the total of 912 coronary angioplasties in their cathlab, from which in 195 cases (21.4%) the primary angioplasty in acute ST elevation myocardial infarction was conducted. IIb/IIIa blockers were administered in the total of 53 cases (5.1% from the whole amount of coronary angioplasties), in 30 cases (15.4% from the total of 195 patients) of the primary coronary angioplasties, unlike the elective procedures, where these agents were given only in 9 patients (1.5% from the overall number of 621 coronary angioplasties) (p < 0.001). The authors in their work analyse the group of patients treated with primary coronary angioplasty with adjuvant treatment of IIb/IIIa platelet blockers., Results: In the stated period the IIb/IIIa platelet blockers were given to 30 patients at the age of 60.3 +/- 11.3 on average (70% were men). The most frequent risk factors were smoking, in 18 patients (60%), and hypertension, in 14 patients (40%). At least one coronary stent was implanted in 20 patients (66.7%). Abciximab was administered in 27 cases (90%) and eptifibatid in 5 cases (10%). Solely in 5 cases (16.7%) the agents were administered at least 10 minutes before the intervention and therefore preventively, and in 25 cases (83.3%) the administration was rescue. The reason for preventive administration was in 3 cases determination of the angiographically high-risk coronary artery disease and in 2 cases the thrombosis of another non-infarction related artery. The most frequent reason for the rescue use was in 6 cases (22.2%) slow-flow or no-reflow fenomena even after the mechanical obstacles and in 5 cases (18.5%) that were successfully treated with further dilatation, the acute in-stent thrombosis was observed. The infarct-related artery was most often the left anterior descending coronary artery, namely in 16 cases (54%)., Conclusion: IIb/IIIa platelet blockers in primary coronary angioplasty administered either preventively or as rescue therapy are highly effective, relatively safe and improve the effectiveness of mechanical reperfusion. The total in-hospital mortality of this group of patients was 10%.