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Unlabelled: At present, primary angioplasty (PTCA) is preferred reperfusion treatment for acute ST elevation myocardial infarction (STEMI). Risk stratification after STEMI includes the evaluation of left ventricular (LV) function. B-type natriuretic peptide testing emerged as a potential marker of LV function and prognosis after STEMI., Aim: The objective was long-term echocardiographic assessment of LV systolic and diastolic function in patients with STEMI who underwent PTCA and to evaluation of the relationship between NT-proBNP plasma levels and LV function. We assessed the value of NT-proBNP in prediction of LV dysfunction after STEMI treated with PTCA., Material and Methods: A series of 98 patients (pts) (75 males, 23 females age from 50.0 to 63.0, mean age 55.0), treated successfully with PTCA in acute phase of STEMI were included in this study. NT-proBNP plasma levels were assessed just before PTCA (BNP-bsl) and at 6 month follow-up (BNP-6m). Transthoracic echocardiography (TTE) was performed at discharge(dc) and at 6 months follow-up (6m). The indices of LV systolic function (LVSF) (LV ejection fraction-EF, wall motion score index-WMSI), LV diastolic function (LVDF) (peak velocity of early (E) and late (A) transmitral flow, E-wave deceleration time (DT), isovolumic relaxation time (IVRT)) and global LV function (Tei index- calculated as a sum of isovolumetric contraction time and IVRT divided by the ejection time) were estimated., Results: At 6 month echocardiographic follow-up we observed the significant improvement of LVSF (the increase of EF (p < 0.0027), the decrease of WMSI (p < 0.0005)) and the deterioration of LVDF (the decrease of E/A (p < 0015), the increase of IVRT (p < 0085)). A negative correlation between BNP-bsl and EF-6m (Rs = -0.2877, p < 0.0072) and BNP-6m and EF-6m (Rs = 0.4125, p < 0.0001) were observed. Multivariate analysis identified BNP-bsl and CPK max during acute phase of STEMI as negative and EF-dc as positive significant, independent predictors of EF-6m., Conclusions: The significant improvement of LV systolic function and LV abnormal relaxation were observed at 6 month follow-up in patients with acute STEMI treated with primary angioplasty. Baseline NT-proBNP plasma level, CPK max plasma level during acute phase of STEMI and echocardiographic LV systolic function indices at discharge are significant and independent predictors of LV systolic function in long-term follow up. Increasing NT-proBNP plasma level at 6 month after STEMI treated with PTCA has a good performance in detecting of LV systolic function deterioration in long-term follow-up.

The purpose of the study was to assess the safety, adverse effects and complications of the dobutamine stress echocardiography (ED). 582 patients without previous infarction were prospectively studied with ED. There were 196 female and 368 male, age varied from 27 to 74 years, mean 52. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg/min. Mean maximal dose achieved was 33 mcg/kg/min. Atropine was added in 253 (43%) cases. Significant coronary artery disease was present in 323 patients (53%). There were no death, no myocardial infarction or episodes of sustained ventricular tachycardia as a result of ED. The test was terminated when following conditions were revealed: target heart rate (28.9%), maximal established dose achieved (25.3%), left ventricular asynergy (19.6%), angina pectoris (10.8%), increase of systolic blood pressure above 220 mm Hg (2.6%), hypotension (7.6%), nonsustained ventricular tachycardia (1.7%). The most common non-cardiac side effects were skin tingling (19.8%), atypical chest pain(16.3%), palpitations (13.9%) and headache (7.9%). The most side effects were usually well tolerated, without the need for test cessation. The ED was terminated only in 4 (0.6%) patients because of non-cardiac side effects including nausea (0.3%) and headache (0.3%). We conclude that ED may be safely performed in routine clinical practice. Side effects were rare and usually minor. Most severe ischemic pain was relieved by test interruption and sublingual nitro-glycerine or short acting beta-blocker administration.