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The purpose of the paper is to define predictors of the kerma-area product (KAP) in percutaneous coronary intervention (PCI). Two new digital X-ray interventional cardiology systems recently installed were included. A total of 398 PCI procedures were carried out by 6 board-certified senior interventional cardiologists with more than 15 years' experience and good knowledge of radiation protection measures. Clinical, radiation and procedural data were collected based on a detailed protocol developed by the SENTINEL cardiology subgroup. Correlation with clinical and procedure factors was then investigated. A significant correlation was found between fluoroscopy time and (i) lesion classification, (ii) the level of tortuosity and (iii) the number of vessels treated. No statistically significant differences were observed in the complexity of the case between operators. However, large differences were found in the KAP among operators, which were mostly attributed to the different number of frames taken by each operator. There was no statistically significant correlation between complexity and the total number of frames. The study showed that, in certain circumstances, the clinical need to successfully perform PCI takes precedence over radiation safety concerns. [ABSTRACT FROM AUTHOR]

The insulin resistance/metabolic syndrome is characterised by the variable coexistence of hyperinsulinaemia, obesity, dyslipidaemia, and hypertension. The pathogenesis of the syndrome has multiple origins, but obesity and sedentary lifestyle coupled with diet and still largely unknown genetic factors clearly interact to produce the syndrome. Dyslipidaemia, the hallmark of the metabolic syndrome, includes increased flux of free fatly acids, raised triglycerides, apolipoprotein B, and small dense low density lipoprotein, and decreased high density lipoprotein cholesterol. The widely prevalent nature of the metabolic syndrome emphasises the importance of its diagnosis and treatment. This review analyses the clinical and dynamic features of this syndrome in the aspect of dyslipidaemia and its management. [ABSTRACT FROM AUTHOR]

To study the electrophysiological effects of oral propafenone on accessory pathways and determine the potential for catecholamine-mediated reversal of these effects, comprehensive electrophysiology studies (EPS) were conducted in 11 patients with manifest (n = 9) or concealed (n = 2) pre-excitation syndrome. EPS were performed at baseline (in the drug-free state), after oral propafenone loading, and with isoproterenol infusion during propafenone therapy. The study group included 10 men and 1 woman with a mean age of 39±13 years, who presented with symptoms of palpitations (n = 6), presyncope (n = 3) and syncope (n = 2). The clinical arrhythmia was atrioventricular reciprocating tachycardia (n = 6), atrial flutter/fibrillation (n = 3), or both (n = 2). During the baseline EPS the accessory pathway location was identified as left (n = 6) or septa (n = 5). The mean anterograde effective refractory period was 265±42 ms, the shortest pre-excited RR interval 259 ± 20 ms and the retrograde refractory period 258 ± 39 ms. Orthodromic atrioventricular reciprocating tachycardia was induced in 10 patients (mean cycle length = 324±31 ms). Antidromic reciprocating tachycardia was induced in one patient (cycle length = 340 ms). In all the 11 patients EPS were repeated after 4 days of oral propafenone loading (668 ± 226 mg daily) when drug steady state was expected to have been achieved. One additional patient had baseline EPS but developed clinical arrhythmia recurrences after propafenone loading and thus he was excluded from the study; follow-up EPS were conducted on procainamide. Propafenone caused complete anterograde block in the accessory pathway in four patients and increased the anterograde refractory period from 270 ±24 ms to 393 ± 124 ms in the other patients, with resultant anterograde conduction occurring exclusively via the atrioventricular node during atrial fibrillation in another three patients. The drug caused retrograde block in three patients, and significantly increased the retrograde refractory period in the other patients (from 248±33 ms to 353±96ms) (P = 0·015). Orthodromic reciprocating tachycardia was rendered non-inducible in six patients or slower and/or non-sustained in the other five patients (cycle length = 400±19 ms, P = 0·012). Isoproterenol infusion testing (3·6±1·6 μg . min) was performed in nine patients during the follow-up EPS. Among the four patients with anterograde block and one of two patients with retrograde block in the accessory pathway, isoproterenol did not restore conduction. However, the anterograde refractory period in three patients decreased from 430 ± 121 to 270±61 ms (P>0·05) and retrograde conduction that was blocked by propafenone was now restored in one patient, while the retrograde refractory period in six patients decreased from 358 ± 106 ms to 295 ±89 ms (P = 0·004). Furthermore, atrial fibrillation rendered non-inducible or non-sustained by propafenone was sustained during isoproterenol infusion, and in four patients in whom reciprocating tachycardia had been rendered slower (cycle length = 405±17 ms) or non-sustained by propafenone, a faster (cycle length = 338 ± 13 ms, P = 0·004) and sustained tachycardia was induced during isoproterenol testing. At a mean long-term follow-up period of 9±6 months, among 10 patients discharged on a combined regimen of propafenone and β-blocker, there have been no supraventricular arrhythmia recurrences and no major drug side-effects. The patient who had no follow-up EPS on propafenone due to clinical arrhythmia recurrences, underwent radiofrequency ablation of his left-sided bypass tract. In conclusion, propafenone constitutes effective drug therapy for patients with pre-excitation syndrome. Its electrophysiological effects on accessory pathways can be partially or completely reversed with acute ... [ABSTRACT FROM PUBLISHER]

In this report we present three cases of ruptured aneurysm of sinus of Valsalva which were detected by colour Doppler echocardiography. The diagnosis was confirmed by cardiac catheterization and at operation. [ABSTRACT FROM PUBLISHER]

We studied the efficacy of propafenone in 16 patients (pts) with exercise-induced ventricular arrhythmias (VA). Propafenone was given in doses of 450 mg (13 pts) to 900 mg (3 pts) per day and was compared with placebo. An arrhythmic index was calculated by dividing the frequency and severity of VA by the duration of exercise test (in min). Propafenone reduced that V A index from 17.05 ± 16.32 to 3.75 ± 7.47 (P < 0.005). In 8 pts the V A were completely abolished, and in 8/10 grade ≥ 3 V A, while no significant change was seen with placebo. In 8 pts in whom exercise had been prematurely terminated because of significant V A, a longer duration was achieved with propafenone (from 4.19 ± 2.74 to 9.39 ± 1.63, P < 002). In those with the same pre-planned duration, a smaller peak heart rate was seen with propafenone. Resting P-R was significantly prolonged. [ABSTRACT FROM PUBLISHER]

We compared the response to a modified Bruce treadmill exercise (EX) protocol lasting 7 min in 5 groups of male individuals free of clinical heart disease: I (age >35 years, N =12), II (age 35–44 years, N=10), III (age 45–54 years, N=13), IV (age 55–64 years, N=13) and V (age <65, mean 70·35±4·67 years, N = 20). The following data were compared:(a) Heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP); resting (R) and their % changes at pre-EX standing and at 3, 6, 7 mi immediately and 2 and 4 min after EX (where EX is a relatively low grade of exercice).(b) The R QS2/QT and PEP/LVET ratios and their % change immediately and 4 min after EX. Resting and peak SBP was higher in groups IV and V.The various groups responded in a similar way to EX. The only significant difference was that the older age group (V) showed on the whole an increase in DBP with EX while groups I–III showed a decrease and group IV no change.This finding may reflect a lesser diminution in vascular resistance with EX in old age. However, inotropic and chronotropic reserves appear similar to those of younger individuals. [ABSTRACT FROM PUBLISHER]

The objective of this study was to investigate the patient and staff doses in the most frequent interventional cardiology (IC) procedures performed in Onassio, the largest Cardiac Centre in Greece. Data were collected from three digital X-ray systems for 212 coronary angiographies, 203 percutaneous transluminal coronary angioplasties (PTCA) and 134 various electrophysiological studies. Patient skin dose was measured using suitably calibrated slow radiotherapy films and cardiologist dose using suitably calibrated thermoluminescent dosemeters placed on left arm, hand and foot. Patient median dose area product (DAP) (all examinations) ranged between 6.7 and 83.5 Gy cm². Patient median skin dose in PTCA was 799 mGy (320-1660 mGy) and in RF ablation 160 mGy (35-1920 mGy). Median arm, hand and foot dose to the cardiologist were 12.6, 27 and 13 µSv, respectively, per procedure. The great range of radiation doses received by both patients and operators confirms the need for continuous monitoring of all IC techniques. [ABSTRACT FROM AUTHOR]

An abstract of the article "Association between daytime blood pressure variability and left ventricular geometry in white-coat hypertension," by V. Barberis and colleagues is presented.

An abstract of the article "Is there any role for baseline brain natriuretic peptide and its changes post dobutamine stress echo for myocardial viability interrogation?" by G. Athanassopoulos and colleagues is presented.

An abstract of the article "Evidence for Interplay Between Cytokines, Macrophage Colony Stimulating Factor and Brain Natriuretic Peptide Plasma Levels Changes During Dobutamine Stress Echo Irrespectively From Test Positivity" by G. Athanassopoulos and colleagues is presented.

An abstract of the article "Integrated evaluation of brain natriuretic peptide and cytocine changes induced by dobutamine stress echo: implications for evolution of ischaemic heart failure" by G. Athanassopoulos and colleagues is presented.

An abstract of the article "Distal left anterior descending artery flow reserve by dobutamine versus adenosine transthoracic Doppler: Clinical application for patency evaluation," by G. Athanassopoulos and colleagues is presented.