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Prieširdžių virpėjimas (PV) išlieka dažniausias ritmo sutrikimas su kuriuo susiduriame klinikinėje praktikoje. Pacientai, kurie turi šį ritmo sutrikimą, turi žymiai didesnę insulto tikimybę, todėl jiems įprasta skirti vitamino K antagonistus (varfariną) arba tiesioginius geriamuosius antikoaguliantus (NGAK). Dėl pacientų jau esamo polimorbidiškumo tinkamai palaikyti terapinę hipokoaguliaciją sudėtinga, todėl galima kraujavimo rizika. Iki šiol sunkios būklės pacientai, kurie dėl gretutinių patologijų arba jau buvusių kraujavimo įvykių, negalėjo vartoti varfarino ir dėl to turėjo vartoti redukuotas NGAK dozes, gydymo aspektu vis sunkiau būdavo išlaikyti pusiausvyrą tarp didžiausios naudos ir mažiausios naujų komplikacijų rizikos pacientui. JAV maisto ir vaistų administracija (angl. American Food & Drug Administration, USFDA), reglamentuojanti ir aprobuojanti naujus gydymo metodus, 2015 m. kovo mėn. patvirtino kairiosios prieširdžio ausytės uždariklių (KPAU) naudojimą. Taigi, pacientams sergantiems nevožtuvinės kilmės prieširdžių virpėjimu ir negalintiems vartoti antikoaguliantų, oficialiai atsirado alternatyva – kairiosios prieširdžio ausytės uždarikliai. Deja, ilgą laiką klinikinės indikacijos implantuoti pacientui KPAU nebuvo aiškiai apibrėžtos ir nebuvo įvertintos intervencinės komplikacijos bei vėlyvieji rezultatai po uždariklio implantavimo. Neseniai atliktų didžiausių atsitiktinių imčių tyrimų (PREVAIL, PROTECT­AF) duomenimis, kairiosios prieširdžio ausytės uždariklio implantavimo procedūra yra efektyvi ir saugi. Tyrimai įrodė, jog sėkmingai atlikus uždariklio implantavimą, sumažėja insulto tikimybė, sumažėja kraujavimo ir mirties rizika lyginant su varfarinu. Esant pakankamam įrodymų kiekiui, 2019 m. gegužės mėn., Kauno klinikose pirmą kartą atlikta sėkminga kairiosios prieširdžio ausytės uždarymo procedūra. Išvada. Remiantis pasauline klinikine praktika ir pirmosiomis patirtimis Kauno klinikose, kairiosios prieširdžio ausytės uždariklio implantavimas yra saugi ir efektyvi procedūra.

Introduction: As coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest survivors. Material and methods: Patients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study. Results: One-hundred-thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion (p = 0.044), but an effect of revascularization on number of deaths was not observed (p = 0.64). The presence of coma (p = 0.005) and the combination of male sex and age above 60-year as 2.2-fold (p = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98–21.63; p = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25–6.90; p = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96–21.24; p = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63–13.66; p < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9–6.72; p = 0.031) to be significant prognostic factors for higher in-hospital mortality rate. Conclusions: We recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.

Introduction. Stenting is a widespread procedure for patients suffering from coronary artery disease. The use of drug-covered stents has improved stenting safety and treatment efficiency. Using second-generation Biolimus drug-covered A9 stents is associated with reduced risk of stent thrombosis compared with first-generation ones. The aim of the study was to evaluate two years’ treatment results after implantation of Biolimus A9 stents in coronary arteries in patients who suffer from coronary artery disease. Methods. The study included 216 patients who suffered from coronary artery disease and were treated using Biolimus A9 drug-covered stents, in order to eliminate all greater-than-50% stenoses. Patients’ data were collected from hospital case histories and e-Biomatrix PMR questionnaire. Decisions regarding whether to use Biolimus A9 stents during percutaneous coronary intervention were made by the respective operators. The rate of complication after stenting was evaluated when stenosis was eliminated or reduced to 30% or TIMI 3 flow was determined. Results. Out of 216 patients included in the study, 151 were males (69.91%) and 30.09% (65) were females. Mean of age of patients was 60.2 ± 10.1 years; 19% of patients had diagnosed diabetes. The success rate of implanting Biolimus A9 stents was 100% with no complications during hospital stay.

Background and objective: The aim of this study was to evaluate and compare various parameters between complete and incomplete ST-segment resolution (STR) patients' groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) (primary outcome). Materials and methods: A total of 203 consecutive patients were divided into two groups according to the degree of STR: &lt, 70% (incomplete) and ≥70% (complete resolution) 5–15 min after the PPCI. The cardiovascular risk factors, sex, Killip class, Thrombolysis in Myocardial Infarction (TIMI) flow, symptom-onset-to-balloon time and door-to-balloon time, and adverse cardiovascular events (secondary outcome) were assessed and compared between two groups. Results: There were 147 patients with incomplete STR and 56 patients with complete STR. Patients with complete STR were younger, had lower Killip class, shorter duration of the chest pain and were less likely to have anterior myocardial infarction (AMI). Patients in the incomplete STR group had longer symptom-onset-to-balloon and door-to-balloon intervals. TIMI3 flow after PPCI was more common in the complete STR group. TIMI flow ≤2 after PCI, AMI and symptom onset-to-balloon time were inversely associated with STR (beta coefficients 28.635, 28.611, and 0.917, respectively). AMI (OR = 29.9), symptom onset-toballoon time (OR = 1.7) and patient's age (OR = 1.1) were associated with an increased likelihood of having incomplete STR. Conclusions: Patients with complete STR were younger, had lower Killip class, shorter duration of STEMI, were less likely to have AMI, were more likely to recover TIMI3 flow. Age, TIMI-flow grade 2 or less after PPCI, AMI and symptom-onset-to-balloon time were associated with STR.

LV function may improve after revascularization of coronary occlusions or using a significant amount of medication. However the quality of life of every patient who is indicated with a acute coronary syndrome is not well characterized. The purpose of the current study was to evaluate the effect of

We present an illustrative case report of the mid-vessel left anterior descending (LAD) coronary artery spasm, which has been enhanced by straightening of the tortuous LAD segment with a guidewire ("accordion effect") thus resistant to intracoronary nitroglycerine and mimicking a coronary artery dissection. Dynamic appearance of this iatrogenic pseudo-lesion upon administration of intracoronary nitrates and recognition of these angiographic phenomena prevented from unnecessary further intervention.

Objective: The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multi- vessel disease (MVD). Materials and methods: A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (&gt, 140 mmHg) were assigned to the first group ( n = 58), with normal ASBP (&lt, 140 mmHg), to the second group ( n = 46), with increased myocardial mass index (MMI) (&gt, 100 g/m2), to the third group ( n = 70), and with normal MMI (&lt, 100 g/m2), to the fourth group ( n = 34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months. Results: There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58% 8.25% vs. 46.8% 7.13%, P = 0.018). Conclusion: Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.

Objective. The aim of present study was to evaluate the diagnostic value of multislice computed tomography coronary angiography in patients with left bundle branch block. Materials and methods. Twenty-four patients who underwent both multislice computed tomography coronary angiography and invasive coronary angiography were enrolled in the study. Findings of these imaging modalities were compared in order to determine the sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography in identifying hemodinamically significant stenoses (≥50%). All segments ≥2 mm in diameter were visually assessed independently from their degree of calcification and image quality. Results. In total, 328 segments were analyzed. The Spearman correlation coefficient between multislice computed tomography and invasive coronary angiography was 0.76 (P&lt, 0.0001). On a per-segment basis, sensitivity, specificity, positive predictive value, and negative predictive value of multislice computed tomography angiography were 75%, 97.7%, 72%, and 98%, respectively, on a per-vessel basis, these values were 77.8%, 92.3%, 70%, and 94.7%, respectively, on a per-patient basis – 81.8%, 84.6%, 81.8%, and 84.6%, respectively.Conclusions. Multislice computed tomography coronary angiography provides a high diagnostic accuracy in detecting significant coronary artery stenoses in patients with left bundle branch block.

Objective. To show differences in the changes of electrocardiographic and echocardiographic data after early and late mechanical recanalization of infarct related artery with and without stent implantation and to assess the value of QRS score in the follow-up period. Material and methods. A total of 248 consecutive patients were divided into these groups: early angioplasty (≤24 hours) without stents (n=114) or with stents (n=6) and later (&gt, 24 hours) angioplasty without stents (n=114) or with stents (n=14). The changes in QRS score and echocardiographic left ventricular ejection fraction during the hospital and 3-month follow-up periods were compared between the groups. Results. QRS score did not increase in a hospital in early or late angioplasty with stents groups, while in the groups without stents especially of early angioplasty increased (2.6±2.5 vs. 3.6±2.4, P=0.001). Left ventricular ejection fraction increased after 3 months only in early angioplasty groups especially with stents (30.0±3.5 vs. 38.4±5.2, P=0.008), but there were no significant differences between the QRS score at discharge and after 3 months (5.4±4.3 vs. 5.0±1.9). Conclusions. Myocardial injury did not increase in a hospital in the cases of early or late angioplasty with stents, while in the cases without stents increased. Left ventricular ejection fraction increased after 3 months only in the cases of early angioplasty especially with the stent implantation, but the QRS score showed no differences, so the QRS score may be not predictive of improvement in ejection fraction at follow-up.

Pirmąją perkutaninę vainikinių arterijų angioplastiką 1977 m. atliko A. Gruentzig. Taigi perkutaninės intervencijos įgavo didelę reikšmę gydant išeminę širdies ligą. Tačiau per pirmuosius šešis mėnesius po vainikinių arterijų angioplastikos procedūrų išlieka tam tikra vidinės kraujagyslės sienelės sluoksnio įtrūkimo ir susiaurėjimo atsinaujinimo (angl. restenosis) rizika. Dviejų didelių klinikinių studijų (STRESS ir BENESTENT) tyrėjai dar 1994 m. įrodė, jog, naudojant kraujagyslių plėtiklius (angl. stent), žymiai sumažėjo susiaurėjimo atsinaujinimo atvejų. Nuo 1994 m. iki šiol kraujagyslių plėtikliai dažnai ir sėkmingai naudojami nepaisant dviejų problemų: poūmės kraujagyslių plėtiklio trombozės (1–2 proc.) ir susiaurėjimo atsinaujinimo (5–40 proc.). Poūmė plėtiklio trombozė įvyksta per pirmąjį mėnesį po procedūros. Jos galima išvengti skiriant ligoniui du antitrombozinius medikamentus, t. y. aspiriną ir klopidogrelį. Nedidelė poūmės plėtiklio trombozės rizika išlieka ir ilgiau nei po vieno mėnesio implantavus vaistus išskiriančius kraujagyslių plėtiklius. To galima išvengti pratęsus antitrombozinį gydymą. Vaistus išskiriantys plėtikliai yra svarbi naujovė intervencinėje kardiologijoje. Naudojant kraujagyslių plėtiklius, kraujagyslės susiaurėjimo atsinaujinimą galima sumažinti iki 3–5 proc. natyvinėse vainikinėse arterijose, jei yra stabili vainikinių arterijų būklė. Tačiau ilgalaikės studijos, kurių metu buvo lyginami standartiniai metaliniai plėtikliai su vaistus... [toliau žr. visą tekstą] Since the first percutaneous transluminal coronary angioplasty performed by A. Gruentzig in 1977, percutaneous coronary interventions have become the most important treatment modality for coronary heart disease. Coronary angioplasty carried a significant risk of coronary flow-limiting dissections and restenosis during the first six months following the procedure. Two main studies comparing percutaneous transluminal coronary angioplasty and coronary stenting (STRESS and BENESTENT) performed in 1994 showed a significant reduction in restenosis rate using stents. Thus, until now stents are the most widely used devices for coronary intervention despite two problems: subacute stent thrombosis (1–2%) and still high restenosis rate (5–40%). Subacute stent thrombosis occurs within the first month after stent placement and can be prevented using the double antiplatelet regimen with aspirin and clopidogrel. Some risk of subacute thrombosis remains beyond the first month when drug-eluting stents are used. This requires prolonged antiplatelet therapy. Drug-eluting stents are the most significant innovation in interventional cardiology. They can reduce the incidence of restenosis in native stable coronary arteries to 3–5%. However, the long-term studies comparing bare-metal stents and drug-eluting stents did not show any significant differences in the rate of major adverse cardiac events (death, myocardial infarction), especially in patients with diabetes after the treatment of... [to full text]

Edvardas Vaicekavicius, Virgilijus Grinius, Ramūnas Navickas, Ramūnas Unikas, Arnoldas Janavicius Kaunas University of Medicine, Institute of Cardiology E-mail: invlab@kmu.lt Background / objective Reperfusion may limit the amount of potentially salvageable ischemic but viable myocardium due to reperfusion damage and injury. The objective of this study was to compare primary percutaneous transluminal coronary angioplasty (PTCA) with stenting according myocardial reperfusion quality in early hospital period. Methods One hundred nineteen patients presenting with acute myocardial infarction < 12 hours were treated by primary PTCA or stenting (n = 26). PTCA patients (n = 93) were divided in to 1st group (n = 75) of survived and 2nd group (n = 18) of died patients. Stented patients consisted 3rd gr. (n = 26). The main indications for stenting after angioplasty were: 1) significant (type D, E, or F) dissection of coronary arteries, 2) significant elastic recoil. Peri-procedural TIMI flow, resolution of ST elevation and evolution of ECG stages were used for assessment of reperfusion quality. QRS score and left ventricle EF were used for assessment of LV function. Results The highest TIMI flow, the most intensive resolution of ST, the evolution of ECG stages and the lowest QRS score were noticed for 3rd gr. of stented patients. The died patients (2nd gr.) had lower TIMI flow (p = 0,097472), higher ST (p = 0,0073) and lower EF (p = 0,0005) in comparing with the 1st gr. of patients. Conclusions The procedural in-hospital outcome demonstrate that coronary stenting can be used as the primary modality for patients undergoing coronary interventions for acute myocardial infarction, increasing TIMI flow myocardial, reducing reperfusion damage and infarct size. Keywords: myocardial infarct reperfusion, myocardial infarct size, primary percutaneous transluminal coronary angioplasty and stenting.