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Introduction: An imbalance between the sympathetic and parasympathetic nervous systems has been indicated in obesity. The aim of the present study was to evaluate the results of tilt table testing (TT) in obese patients., Methods: 59 patients with simple obesity (F/M: 50/9; BMI: 36.9+/-3.9 kg/m(2)), and 19 healthy subjects of the control group (F/M: 16/3; BMI: 24.7+/-4.3 kg/m(2)) were examined. Additionally, TT was carried out in 11 patients from the obese group after a 3-month weight reduction treatment. We evaluated HR (heart rate), SBP (systolic blood pressure), DBP (diastolic blood pressure): values at rest, post-inclination values (HRt-1, SBPt-1, DBPt-1), differences between the maximum and minimum values as obtained on TT (HRt-range, SBPt-range, DBPt-range), and % differences of HR (%HRt-increase, %HRt-decrease, %HRt-range)., Results: A positive TT response was observed in 10 obese patients, and in none of the controls. Higher differences of HR values were observed in the obese (P<0.05) in comparison to control group. Patients with a positive TT response presented a significant increase in HRt-1, HRt-range, and %HRt-range when compared to negative TT and controls (P<0.02). A 3-month weight reduction treatment resulted in a decrease in HR at rest, and decrease in SBP and DBP-both rest values and values after table-inclination., Conclusions: A positive TT response is observed more often in patients with simple obesity. HR reaction to tilting varies between the patients and controls. A 3-month weight reduction treatment influences the cardiovascular response to tilting. Our results seem to support the hypothesis of autonomic imbalance in obesity.

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.

In 42 patients the 24-hour ECG was performed before and on the fifth day after the elective coronary artery bypass grafting. In general 34 bouts of atrial fibrillation occurred in 14 patients. According to frequency analysis of the HRV 23 (67.6%) of these paroxysms were found sympathetically driven, 6 (17.6%) vagally driven and 5 (14.7%) undefined. The predominating role of adrenergic activation in the initiation of the bouts of atrial fibrillation in this group of patients suggests the need to use adequate doses of beta-adrenolytic agents during the perioperative period of ischaemic heart disease treatment.

Background: Adhesion molecules have been suggested as mediators of atherosclerotic inflammatory process. They may contribute to the pathogenesis of stable and unstable angina., Methods: The study group consisted of 59 patients with coronary artery disease: 27 patients with stable exertional angina (group A), 32 patients with unstable angina (group B). 20 healthy persons acted as controls (group C). Serum levels of soluble Intercellular Adhesion Molecule 1 (sICAM-1), Vascular Cell Adhesion Molecule 1 (sVCAM-1), sE-selectin, sP-selectin were measured both before and after the treadmill ECG stress test in groups A and C. In group B the measurements were carried out at 6, 24, and 48 hours following an episode of chest pain., Results: There were no differences between the baseline serum levels of adhesion molecules as determined in groups A and C. In patients with stable angina, the post-exercise concentrations of sE-selectin were significantly higher (68.8+/-29 ng/ml) in comparison to both baseline- (38.7+/-15 ng/ml), and group C-values (pre-exercise: 35.1+/-16; post-exercise: 49.9+/-15 ng/ml). In unstable patients, serum sP-selectin (190.1+/-99 ng/ml) and sVCAM-1 levels (1359+/-299 ng/ml) were higher when compared to those found in groups A (142.3+/-24; 962+/-352 ng/ml, respectively) and C (136.4+/-33; 851+/-168 ng/ml, respectively)., Conclusions: Serum levels of soluble adhesion molecules in patients with stable angina are comparable to those of healthy persons. Stress test-induced increase of sE-selectin concentration may reflect endothelial response to exercise. Unstable angina is characterized by significant elevation of sP-selectin and sVCAM-1 serum levels which seems to be related to enhanced platelets and leukocytes activation.

Background: Cytokines may play a role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Methods: We examined serum concentrations of selected pro- (TNFalpha, IL-2) and anti-inflammatory (IL-10) cytokines, and soluble forms of TNF receptors (sTNFR 1 and sTNFR 2) by ELISA in 45 patients with stable exertional angina (group 1), 32 patients with unstable angina (group 2), and 20 healthy subjects (group C). Results: Serum concentrations of both TNFalpha (group 1, 18.3; group 2, 17.2 pg/ml; P<0.001) and IL-10 (group 1, 46.1; group 2, 41.5 pg/ml; P<0.05) were significantly higher in patients with CAD than in group C (8.3 and 14.3 pg/ml, respectively). sTNFR 1 serum level was higher in group 1 (1399.6; P<0.05) than in healthy volunteers (1093.9 pg/ml). In turn, the serum level of IL-2 was significantly higher in unstable patients than it was in groups 1 and C (89.4, 59.8 and 52.8 pg/ml, respectively). In group 1, both TNFalpha and IL-2 correlated with serum lipids. Conclusions: Patients with CAD, irrespective of the form of the disease, have higher serum levels of pro- and anti-inflammatory cytokines than control subjects. Increased concentrations of IL-2 in unstable angina may suggest additional immunologic activation. The pro-inflammatory cytokine levels seem to be related to lipid disturbances.

Background: There is growing evidence that cytokines play a pathogenic role in both heart failure and atherosclerosis. The aim of our study was to assess serum levels of selected cytokines and soluble forms of receptors in patients with coronary artery disease (CAD), and the relation between these concentrations and left ventricular (LV) systolic function., Material/methods: We measured serum levels of TNFalpha, sTNFR 1 and 2, IL-2, and IL-10 in 100 patients with CAD: 70 patients with LV regional wall motion disturbances (group A); and 30 patients with normal LV function (group B). The control group (group C) consisted of 20 healthy volunteers., Results: Mean serum TNFalpha and IL-10 concentrations were significantly higher in groups A (18.3 +/- 3.5; 55.4 +/- 118.5 pg/ml) and B (17.9 +/- 4.9; 45.3 +/- 76.8 pg/ml) than in controls (8.3 +/- 1.4, p<0.001; 14.3 +/- 28.5, p<0.05; respectively). Moreover, in group A serum levels of sTNFR 1 were higher (1367.4 +/- 531.1 pg/ml) than in group C (1093.9 +/- 456.9 pg/ml; p<0.05). No differences were found in the study groups between serum sTNFR 2 and IL-2 levels. In group A, both the LV ejection fraction and motion score index correlated with TNFalpha (r=-0.277; r=0.282; p<0.05), and sTNFR 1 levels (r=-0.258; r=0.280; p < 0.05)., Conclusions: The serum concentrations of TNFalpha and IL-10 are increased in patients with CAD. Additionally, patients with impaired LV contractility have higher sTNFR 1 concentrations. Serum cytokine activation may play a role in the development of heart failure in patients with CAD.

Unlabelled: The aim of the study was to evaluate the QT dispersion and the severity of arrhythmias in hypertensive patients according to the asymmetry of the left ventricular hypertrophy. The study group consisted of 47 hypertensive patients. In 24 of them the left ventricular hypertrophy was symmetrical (group I) and in 23--asymmetrical (group II). For the evaluation of the left ventricular hypertrophy its thickness was analyzed in 13 segments. The ratio between the maximum and minimum thickness from any location was determined as the asymmetry index (AI). The value of this index 1,3 distinguished between patients with the symmetrical and asymmetrical left ventricular hypertrophy. 20 healthy subjects were examined as a control group (group III). All subjects underwent physical examination, the standard 12-lead electrocardiogram (ECG), twenty-four hour Holter recording and echocardiography. All the results for the QT dispersion (QTd, QTdc, QTdR) were highest in group II, lower in patients from group I and the lowest were observed in the control group. The differences in all parameters between group I and II were statistically significant: for QTd--V p < 0.01, QTdc--p < 0.05, QTdR--p < 0.05. The differences between groups II and III as well as I and III were statistically significant for all QT dispersion parameters: for QTd--p < 0.001 and p < 0.01 respectively, QTdc--p < 0.001, QTdR--p < 0.001 for both groups. We have observed a very distinct positive correlation between the asymmetry index and QTd, QTdc, QTdR (p < 0.001). These values correlated also, but less distinctly with the left ventricular mass index--LVMI (p < 0.05). The frequency and severity of ventricular ectopic beats did not differ significantly between group I and II. The results obtained indicate the lack of connection between the frequency of ventricular premature complexes and (1) all QT dispersion parameters, (2) LVMI, (3) AI. Supraventricular premature complexes occurred significantly more frequently in patients with the asymmetrical left ventricular hypertrophy compared to the group with the regular left ventricular hypertrophy (p < 0.05) and control group (p < 0.01)., Conclusions: The left ventricular hypertrophy in primary hypertension may increase the QT dispersion. It seems that asymmetry of the left ventricular hypertrophy reinforces this increase. The increased QT dispersion in primary hypertension does not influence significantly the occurrence of ventricular arrhythmias.

Unlabelled: Evidence for the role of chronic inflammation in atherogenesis has been well documented. Selectins mediate the first step in leukocyte adhesion and may contribute to the pathogenesis of stable and unstable angina., Methods: The study group consisted of 59 patients (pts) with coronary artery disease (CAD) documented coronarographically: 27 pts with stable exertional angina (group A), 32 pts with unstable angina (group B). 20 healthy persons were the control group (group C). Serum levels of E-selectin and P-selectin were measured by ELISA method both before and after the treadmill ECG stress test (ST) in groups A and C. In group B the measurements were carried out at 6, 24, and 48 hours following an episode of chest pain., Results: There were no differences between the baseline serum levels of selectins as determined in groups A and C. In patients with stable angina, the post-ST concentrations of E-selectin were significantly higher (68.8 +/- 29 ng/ml) in comparison to both baseline (38.7 +/- 15 ng/ml), and group C-values (pre-ST: 35.1 +/- 16; post-ST: 49.9 +/- 15 ng/ml). In unstable patients, serum P-selectin levels were higher when compared to those found in groups A and C (group A: 142.3 +/- 24; group B: 190.1 +/- 99; group K: 136.4 +/- 33 ng/ml). No differences between selectins concentrations were observed at fixed times after an episode of chest pain., Conclusions: Soluble selectins levels in pts with stable angina are comparable to those of healthy persons. Significant increase of E-selectin concentration as induced by ST may reflect endothelial response to exercise. Patients with unstable angina had elevated levels of P-selectin, which seems to be associated with enhanced platelet and leukocyte activation. The serum levels of selectins may indirectly reflect clinical condition of pts with CAD.

Recent studies have proved close relations between cardiovascular and endocrinic systems. This relation has been observed in acromegaly, the disease connected with unrestrained secretion of growth hormone. The aim of the study was to assess Holter monitoring and echocardiography of acromegalic patients. The study group consisted of 28 acromegalic patients, including 15 patients with hypertension, was considered. As control groups we examined 20 patients with essential hypertension and 20 normotensive healthy subjects: All subjects underwent twenty-four hour Holter recordings, complete M-mode, two-dimentional and spectral Doppler echocardiography. Ventricular premature complexes occurred in 65% of acromegalic patients. Frequency and severity of ectopic beats were significantly increased compared to control groups. Left ventricular ejection fraction was considered to be normal, although significant decreased compared to healthy subjects. Left ventricular mass was above normal value in acromegalic patients--no significant difference was found between hypertensive and normotensive acromegalics. Doppler examination has shown the abnormalities of left and right ventricular filling in 89% of acromegalics. We have observed the correlations between left and right ventricular filling indices and the duration of the disease, and left ventricular mass. Left ventricular hypertrophy frequently occurs in acromegalic patients and this is not simply secondary to systemic hypertension. The prevalence of ventricular arrhythmias in acromegalic patients seems to be associated with left ventricular hypertrophy. Doppler examination suggests impaired left and right diastolic filling in patients with acromegaly.

TNF-alpha as a pleiotropic, proinflammatory cytokine seems to play a role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). TNF-alpha is binding to two cell surface receptors and its serum activity is modified by soluble forms of these receptors: sTNF-R I and sTNF-R II. The aim of this study was to assess serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II in patients (pts) with CAD. We examined serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II by ELISA in: 45 pts with stable exertional angina (group I); 32 pts with unstable angina (group II) within 6, 24, and 48 h after the chest pain; and 23 pts before and 6, 24, and 48 h after PTCA (group III). The control group (group C) consisted of 20 healthy subjects. We evaluated: clinical state of patients and results of some diagnostic examinations (lipids, ECG, echocardiography, coronary angiography). Mean serum concentrations of TNF-alpha were significantly higher in pts ith CAD (group I: 18.25 +/- 5.5 pg/ml; group II: 17.24 +/- 4.0 pg/ml; group III: 18.70 +/- 0.6 pg/ml; p < 0.001) than in healthy pts (8.31 +/- 1.4 pg/ml). In turn mean serum concentrations of sTNF-R I were significantly higher both in group I (1399.6 +/- 536.3 pg/ml; p < 0.05) and III (1544.0 +/- 391.4 pg/ml; p < 0.01) than in control group (1093.9 +/- 456.9 pg/ml). There were not differences in mean serum concentrations of sTNF-R II. We found no differences between mean serum concentrations of TNF-alpha, sTNF-R I and sTNF-R II either after the chest pain (group II); or before and after PTCA (group III). In group I mean TNF-alpha correlated with serum triglycerides and HDL-cholesterol (r = 0.412 and r = -0.424; p < 0.01); sTNF-R I correlated with LDL-cholesterol (r = -0.309; p < 0.05); and sTNF-R II correlated with total cholesterol and LDL-cholesterol (r = 0.311 and r = 0.316; p < 0.05). The serum concentrations of TNF-alpha are increased in patients with CAD, but this does not reflect the clinical state of patients. In pts with stable angina these increased levels of TNF-alpha may be accompanied with higher concentrations of sTNF-R I--it seems to be the compensatory mechanism in long-term atherosclerosis. Lipid disturbances may influence the cytokines metabolism in pts with CAD.

Unlabelled: Obesity is known to be a risk factor of cardiac death, that is associated first of all with cardiac arrhythmias. Increased QT dispersion (QTd) and ventricular late potentials (LP) are measurable indices of ventricular arrhythmias risk. The aim of this study is to asses QTd and LP in women with obesity. 62 obese women (mean BMI 36.7 kg/m2) and 15 apparently healthy subjects (mean BMI 24.5 kg/m2) were included in our study. QTd and correlated QT interval dispersion (QTdc) were calculated from 12-lead ECG. LVM were assessed from echocardiograms. LP were obtained by signal averaging of surface electrocardiograms., Results: QTd, QTdc, LVM were significantly higher in patients. We found LP in six cases and higher QTdc in this subgroup. According to our research, increased QTd in obese women seems to be associated with left ventricular hypertrophy and increased QTd is significantly higher in subjects with LP.

Unlabelled: Myocardial perfusion scintigraphy is a non-invasive method helpful for evaluating the coronary heart disease. Its use may be particularly indicated in cases of inconclusive ECG (i.e. in left bundle branch block, LBBB). On the other hand there are observations indicating the decreased accumulation of the radiotracer in the septal segments of myocardium in patients with left bundle branch block (LBBB). This phenomenon previously described for the thallium-201, recently was also reported in the MIBI 99mTc studies. Purpose of the present study were: (1) to check the frequency of the diminished uptake of the radiotracer (MIBI 99mTc) in the LBBB patients, and (2) to test its interference with the evaluation of the coronary heart disease., Materials and Methods: Our observation material included 42 patients in mean age 49 +/- 7 yr (26 women) divided into 3 groups: Group I--12 patients without intraventricular conduction disorders and with normal coronarography (the reference group), Group II--15 patients with LBBB and no signs of coronary artery disease in angiography and Group III--15 patients with LBBB and coronary artery disease confirmed by angiography. All patients underwent stress-rest perfusion scintigraphy according to a 2-days protocol. Submaximal bicycle exercise test was performed using the Bruce protocol. A single-head SPECT scintillation camera (DIACAM-Siemens) was used to acquire 64 views over 180 degrees. Acquisition was started 60-90 minutes after injection of MIBI 99mTc (800 MBq). After generating tomographic images their reorientation towards the left ventricle axes and creating the bull's eye polar maps were carried out with the aid of manufacturer's programs., Results: The mean decrease of the radiotracer accumulation in the septal segment was similar in both groups of patients with LBBB (32.7 +/- 9.5 vs 28.5 +/- 8.6 in stress and 27.6 +/- 9.5 vs 27.5 +/- 7.9 in rest in groups II and III, respectively). It was, however, significantly less pronounced in the reference (I) group (the mean decrease being 17.7 +/- 4.7 or 16.9 +/- 5.5 in stress and rest studies, respectively). Distribution of MIBI 99mTc in the myocardium was more homogeneous in the reference group (the maximal differences of the radiotracer accumulation never exceeded 45%) than in the LBBB groups. In the group II defects of the maximal depth over 46% were observed in 9 patients (60%), and in the group C in 12 patients (80%). In 6 patients of the latter group maximal depth of decets exceeded 56% (value never found in group II)., Conclusion: The diminished uptake of MIBI 99mTc in the septal segment of the left ventricle is a common phenomenon. In some cases it may interfere with the evaluation of the perfusion scintigraphic studies. The more pronounced defects, however, may be significant for the coronary artery disease.

Recent findings suggest that inflammation and cytokines regulation may play a role in the pathogenesis of atherosclerosis and coronary heart disease. The aim of this study was to assess serum concentrations of selected pro- (TNF alpha) and antiinflammatory (IL-10) cytokines in patients with coronary heart disease. We studied 29 patients with coronary heart disease: 14 with stable angina (group I) and 15 with unstable angina (group II). The control group (group K) consisted of 10 healthy subjects. Patients with inflammatory diseases, previous myocardial infarction (last 6 months) and with ECG abnormalities, that would invalidate ST-segment analysis, were excluded from examined groups. We evaluated: clinical state of patients and results of some diagnostic examinations (lipids, ECG, echocardiography, coronary angiography, concomitant diseases). In each patients serum levels of TNF alpha and IL-10 were measured according to the special protocol by ELISA. The mean serum concentrations of TNF alpha and IL-10 were significantly higher in group I (respectively: 18.75 +/- 11.7 pg/ml, 89.0 +/- 114.9 pg/ml) and II (14.21 +/- 5.9 pg/ml, 49.38 +/- 72.9 pg/ml) in comparison to the healthy subjects (9.41 +/- 1.7 pg/ml, 9.69 +/- 4.5 pg/ml). We found positive correlations between mean TNF alpha and IL-10 concentrations in group II (48 hours after last symptom) and between mean TNF alpha concentration and LVM (left ventricular mass), LVMI (left ventricular mass index) in group I. The concentrations of TNF alpha and IL-10 did not correlate with other clinical parameters. The results of our study suggest that serum concentrations of pro- (TNF alpha) and antiinflammatory (IL-10) cytokines may be increased in patients with stable and unstable angina. These increased concentrations do not reflect the clinical state of patients.

Unlabelled: The risk of sudden cardiac death is higher in patients with obesity, particularly in the upper body obesity. The most common cause of cardiac events are serious ventricular arrhythmias. Delayed cardiac repolarization leading to the prolongation of the QT interval is a well characterised precursor of arrhythmias. The QT interval dispersion reflects inhomogeneity of repolarization. The aim of this study was to assess QT interval dispersion (QTd) in obese women and to establish the relationship between obesity and QTd. 62 patients with obesity (group 1) and 15 apparently healthy women (group 2) were included in our study. Obese subjects were distinguished in accordance to the waist to hip ratio (WHR) into three subgroups: 1a--obese women with upper body obesity; 1b--obese women with WHR: 0.75-0.85; 1c--obese women with lower body obesity. A standard 12-lead ECG was performed in each subjects and QTd, QTdc (QT correlated interval dispersion), QTdR (QTd ratio) were calculated. The left ventricular mass (LVM) and left ventricular mass index (LVMI) were obtained from echocardiograms. We found QTd, QTdc, QTdR and LVM, LVMI to be significantly higher in obese women as well as positive correlation between BMI and both LVM, LVMI. QTdR was significantly higher in subgroup 1a compared with subgroup 1c., Conclusions: 1) QT interval dispersion was increased in obese women compared with healthy subjects, 2) supposedly increased QTd was associated with the type of obesity.

Cytokines are hormone-like proteins playing very important role in the cellular interactions. They are produced by the immunological as well as the cardiovascular system structural cells. Cytokines are pathogenic factors in many disorders, where inflammation etiology is suspected such as heart failure and atherosclerosis. Cytokines stimulate proliferation processes in the vascular wall for example restenosis after percutaneous coronary angioplasty. It is suggested, that wider knowledge of cytokines and their role in cardiovascular diseases may be of future clinical importance.

The aim of this study was to compare the diurnal blood pressure (BP) profile in the same persons performing the same work at different hours: at first examination: 06.00 to 14.00 day hours; the second examination: 22.00 to 06.00 night hours. The study group consisted of 20 men working in a power station. They were all doing similar work at the same working place (the handling of electric generators). In each subject 24 h BP monitoring (Excel Oxford Medical) was performed twice, during day and night working hours. Only eight subjects (40%) had a similar diurnal BP profile during both examinations. The BP profile of the other 12 subjects (60%) showed distinct differences. However, we have not observed any common or characteristic pattern in them. These results suggest that the time of working may be an important factor changing the diurnal variation of BP. To ascertain why it is not true for all examined subjects needs further exploration.

The informations about the dependence of sinoatrial conduction time (SACT) on heart rate (HR) are unequivocal. The aim of the study was to establish if such a dependence really exists. The study group comprised 24 patients (9 women and 15 men) aged 42-71 years, mean 55.8. All the patients presented atrial premature contractions of various etiology. No agents affecting heart electrophysiology were administered until the study was completed. In every patient SACT was estimated by means of the Strauss formula from the 24-hr ecg and from transoesophageal single impulse stimulation. SACT obtained from 24-hr ecg was 156.2 +/- 33.1 ms; whereas the one respectively, calculated from the transoesophageal stimulation was 119.0 +/- 21.0 ms. Despite a significant difference between the results (p less than 0.001), the SACT values obtained with both methods correlated well with each other (r = 0.712; p less than 0.01). The dependence of SACT on basic heart cycle length was observed in 9 pts during 24-h ecg (37.5%). Among these pts SACT was shortened with higher and lengthened with lower HR. In the remaining 15 pts this dependence didn't occur, neither it occurred in any patients examined with the single impulse stimulation. The results suggest that the dependence of SACT on HR is not a constant phenomenon and that it occurs only in a part of the examined population.

Thyroid function was evaluated in 31 patients with disturbances of heart rhythm both before and after 13 months of treatment with amiodarone. An increase in blood serum T4 concentration and transient increase (only during the first three months of treatment) in TSH concentration have been observed in almost all the patients studied. Clinically evident form of hyperthyroidism was found only in one female patient. In two patients the changes in hormone concentrations suggesting hyperthyroidism were not accompanied by clinical manifestations, and in four patients there was no clinical hypothyroidism despite hormone levels suggesting such a state. In addition to the determinations of T3, T4 and TSH also the results of TRH-TSH test played an important role in diagnosing both hypo- and hyperthyroidism.