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Unlabelled: Dobutamine stress echocardiography (DSE) is widely used for diagnosis of coronary artery disease (CAD). However, data regarding the diagnosis of coronary artery disease in patients with moderately elevated maximal gradient across the stenosed aortic valve (AS) are limited. This study was designed to the value of DSE in the diagnosis of CAD in women with moderately elevated maximal gradient across the AS., Patients and Methods: DSE was performed in 162 patients within the multicentre study. The group included 58 (mean age 61 +/- 13 years) females and 104 (mean age 58 +/- 13 years) males. DSE was performed with step-wise infusion every three minutes (5, 10, 20, 30 and 40 microg/kg/min). If the target heart rate was not reached, a further dose of 40 mcg/kg/min. together with atropine 0.25-1 mg was administered, in the absence of signs and symptoms of ischemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography. Coronarography was performed according to generally accepted indications. The significant coronary artery disease (>1 = 50% luminal diameter stenosis) of one of the major epicardial vessel was accepted as positive result for making the diagnosis of CAD., Results: There was significant difference at rest between women and men with regard to left ventricular diastolic diameter (47.7 +/- 6.5 vs 55.6 +/- 8.8 mm), systolic diameter (30.1 +/- 7.9 vs 38.1 +/- 11.5 mm), ejection fraction (67 +/- 12 vs 55 +/- 17%), wall motion score index (1.05 +/- 0.17 vs 1.22 +/- 0.36) p<0.001. There were also a significant difference in left ventricular mass index and diastolic septum diameter (131 +/- 48 vs 152 +/- 46) and (12.5 + 2.7 vs 13.5 +/- 2.6 mm). Dobutamine peak dose was 31 +/- 11 microg/kg/min. The mean heart rate, mean systolic pressure and diastolic pressure were 114 +/- 26/min, 143 +/- 26 and 81 +/- 15 mmHg respectively. Sensitivity, specificity, and accuracy of DSE for the diagnosis of CAD in women were 77.8%, 95.8% and 90.9%. Those in men were 72.7%, 78.8% and 75.6%, respectively (NS)., Conclusion: The diagnostic value of dobutamine stress echocardiography for the diagnosis of coronary artery disease in women with stenosed aortic valve is high. DSE is good method for the diagnosis.

Cytokine activation may be connected to increase of clinical symptoms both of coronary heart disease and lower limbs atherosclerosis. Our aim is to determine the influence of the atherosclerosis generalization upon immune activation in coronary heart disease, with regard to ECG stress test. 127 patients have been included in the study: 21 with stable angina and peripheral artery disease (PAD)--group A, and 106 with stable angina--group B. 20 healthy persons comprised the control group (group K). The serum concentration of TNF alpha, sTNFR 1, E-selectin and sVCAM-1 has been measured before and after the ECG stress test, using the ELISA method. Serum concentration levels of TNF alpha (A: 17.8 +/- 6.2 pg/ml, B: 17.4 +/- 3.8 pg/ml) and sTNFR 1 (A: 1678.5 +/- 600 pg/ml, B: 1376.4 +/- 558 pg/ml) have been significantly higher in both research groups than in the control group K (8.3 +/- 1.4 pg/ml, p < 0.001; 1093.9 +/- 457 pg/ml, p < 0.01). The sTNFR 1 concentration has been significantly higher in group A than in group B (p < 0.05). A significant post-exercise increase in E-selectin serum concentration has been observed, regardless to coincidence of lower limbs atherosclerosis. The atherosclerosis generalization level, e.g. the prevalence of PAD, in patients with coronary heart disease has an influence on immune activation--patients with lower limbs atherosclerosis are characterized by higher sTNFR 1 serum level. The ECG stress test induces the increase of E-selectin serum concentration in coronary patients, regardless of PAD.

Myocardial infarction (MI) is the direct cause of 40% of all deaths, independently of the high standard of medical treatment. The main aim of the study was to define the relationship between the declarative health model (declarations) and the real health activity of the sufferers (realization). The research was performed on 107 patients after acute MI, hospitalized in the Cardiology Department Medical University of Silesia. They were questioned in direct interviews. In addition, the modified form of Shalit's circle was applied. The results indicated the coexistence of two health models of patients. In declarations, there is a model of person with interior attribution of MI (90.65%) that has a feeling of ability to influence his/her health (e.g. through the lifestyle: 63.55%; an individual's character: 41.12%). In realization, there is a model of sick patient with exterior attribution of heart attack (e.g. political and economic crisis, innate predisposition). A similar tendency in the perception of health factors and planning of changes after MI was observed. For instance, 50.47% patients talked about "the increase caution" or "slowing down" as a new planned form of activity. Moreover, of 92% patients who have the social support only 33.64% consider that as an important factor for health. The results suggest a divergence between declarations and real health activity. The launched health model of beliefs seems to be too costly and not attractive enough. Taking into consideration the complete risk factors in MI and making the proposed health belief system more accessible seem to be essential for creating an adequate prevention program.

Unlabelled: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men., Conclusions: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.

A case of 65 year old male with acute myocardial infarction is described. The patient underwent successful primary coronary angioplasty with the use of a distal embolic protection device.

Background: Reperfusion therapy reduces mortality rate in patients with acute myocardial infarction with ST-segment elevation (STEMI)., Aim: The aim of the study was to access the early outcome of patiens (pts) with STEMI admitted to Upper Silesian Cardiology Centre in 2002., Methods: 957 pts with AMI were enrolled into the study. The influence of several factors on in-hospital mortality was analised., Results: Out of 957 pts 51 died during hospitalization (5,3%). Coronary angiography was performed in 98,0% of pts. Primary PTCA was performed in 94,5% of pts. Stents were implanted in 85,9% of patients who underwent PTCA. The following factors significantly contributed to increased mortality among pts with acute myocardial infarction: female sex (p<0,02), multivessel disease (p<0,05), age above 65 yrs (p<0,001), time from the onset of chest pain above 6 hours (p<0,01) and 12 hours (p<0,001). The use of GP IIB/IIIA inhibitors significantly reduced the mortality rate (p<0,05). Cardiogenic shock was the only independent factor of the increased risk of mortality in multivariate regression analysis (p<0,0001) with relative risk of death (RR 33,5). The mortality rate in pts with shock was 40,2%: 70,8% in case of conservative treatment, 70% in the group of failed PTCA and only 17,2% in the group of successful PTCA. Among pts who underwent primary PTCA the failure to restore coronary blood flow of the infarct related artery contributed to increased relative risk of death (RR 14,5) (p<0,001). Stents improved the survival rate (p<0,01). In PTCA group cardiogenic shock and failed PTCA were independent risk factors in multivariate regression analysis., Conclusions: The results of our study show low rate of in-hospital mortality in pts without cardiogenic shock (1,2%). PTCA is highly successful method of treatment of pts with shock with mortality rate 17,2% in pts who underwent successful procedure.

Objective: The inflammatory processes as well as the lipid disturbances play an important role in the pathogenesis of atherosclerosis. The aim of the study was to evaluate the influence of the hyperlipidaemias on serum levels of tumour necrosis factor (TNF) alpha, the soluble form of TNF receptor (sTNFR) 1 and 2, Interleukin (IL)-10 in patients with stable coronary artery disease (CAD)., Methods and Results: The study group comprised 94 consecutive admissions with stable CAD: 39 patients with hypercholesterolaemia (group HC), 22 patients with mixed hyperlipidaemia (group HL) and 33 patients with normal lipids (group NL). Twenty healthy volunteers were the controls (group C). Serum TNFalpha levels were higher in all CAD groups (p < 0.001) than in healthy subjects. Mean serum concentrations of sTNFR 1 were significantly higher in group NL (p < 0.05) in comparison both to group HC and controls. IL-10 levels were higher in group HC than in controls (p < 0.5). In all CAD patients TNFalpha showed a negative correlation with HDL-cholesterol (p < 0.001) and a positive correlation with triglycerides (p < 0.00 1). Moreover, sTNFR 1 and IL-10 showed a negative (p < 0.05) and sTNFR 2 a positive correlation with LDL-cholesterol (p < 0.001)., Conclusions: CAD patients are characterized by increased serum concentrations of TNFalpha. It seems likely that immune activation (TNFalpha, sTNFR 1, sTNFR 2, and IL- 10) in CAD patients is related to serum lipids levels.

Echocardiographic examination at rest is usually an adequate diagnostic method in evaluating patients with aortic stenosis and in assessing the severity of stenosis. However, in patients with aortic stenosis with coexisting coronary heart disease and in patients with poor left ventricular systolic function and low gradient aortic stenosis, dobutamine stress echocardiography should be performed. This test is helpful in differentiating between significant fixed aortic stenosis with secondary left ventricular dysfunction and severe left ventricular dysfunction coexisting with nonsignificant aortic valve stenosis. This examination is necessary to select the proper method of treatment and is helpful in risk stratification.

The Aims: The aim of the study was to assess the safety of dobutamine echocardiography (DE) in patients with aortic stenosis and left ventricular ejection fraction < or = 45%., Methods: 162 patients (mean age 59 +/- 13, 64% males) with resting transvalvular peak gradient < 70 mmHg underwent standard DE (doses 5-40 micrograms/kg/min) in a multicenter study involving 10 centers from Poland and Hungary. This analysis involves a subset of 39 pts (34 M, 5 F, age 59 +/- 13) identified according to the criterion of EF < or = 45% and mean aortic gradient < or = 35 mmHg. Clinically indicated coronary arteriography was performed in all patients with left ventricular dysfunction., Results: Peak dobutamine dose was 29 +/- 10 micrograms/kg/min. Peak heart rate was 112 +/- 26 bpm. Systolic arterial pressure was 148 +/- 20 mmHg and diastolic pressure 86 +/- 14 mmHg. Transaortic mean gradient and aortic valve area increased 35 +/- 34% and 19 +/- 15% during peak dobutamine dose, respectively. Ejection fraction improved 16 +/- 14%. The test was positive in 17 (43.6%) patients, negative in 11 (28.2%) patients and non diagnostic in 11 (28.2%) patients. There were no deaths, myocardial infarctions or episodes of sustained ventricular tachycardia as a result of DE. The test was terminated when the following conditions were met: Target heart rate (23.%). Left ventricular asynergy (46.2%). Maximal established dose achieved (7.7%). Side effects (20.5%). The most common side effects were ventricular arrhythmias (35.9%), dyspnea (20.5%) and hypotension < 20 mmHg (10.3%)., Conclusion: Despite frequent side effects, DE can be safely performed in patients with aortic stenosis and depressed left ventricular contractility.