Search

PurposeCardiac rehabilitation (CR) improves clinical outcomes in patients with cardiovascular disease (CDV). Patients with CVD often have multiple comorbidities, including obstructive sleep apnea (OSA), potentially affecting their ability to participate and achieve functional improvement during CR. We aimed to test the hypothesis that OSA reduces peak exercise capacity (EC) in patients undergoing CR and to explore if OSA treatment modifies this relationship.MethodsData from a retrospective cohort of CR patients was analyzed. OSA was defined as a respiratory event index > 5/h or physician diagnosis. Patients with OSA were considered "treated" if using continuous positive airway pressure regularly during the CR period. Change in METs was the primary study outcome.ResultsAmong 312 CR patients, median age of 67 years, 103 (33%) had known OSA (30 treated, 73 untreated). Patients with OSA vs. those with no OSA were more likely to be obese and male; otherwise, groups were similar. Compared with the no OSA group, patients with OSA had lower pre-CR METs (3.3 [2.9-4.5] vs. 3.9 [3.1-5], P = .01) and lower post-CR METs (5.3 [4-7] vs. 6 [4.6-7.6], P = .04), but achieved a similar increase in METs post-CR (1.8 [0.6-2.6] vs. 2.0 [0.9-3], P = .22). Furthermore, compared to no OSA, pre-CR and post-CR METs tended to be similar in patients with treated OSA, but lower in untreated patients, with similar increases in METs across all groups, even when adjusting for covariates via multivariable regression.ConclusionOSA is prevalent in patients with CVD undergoing CR. CR substantially improves exercise capacity independent of OSA status, but screening for-and treatment of-OSA may improve the absolute exercise capacity achieved through CR.

The study was carried out in 2005-06 in the experimental orchard at Garlica Murowana in the Kraków area. The effect of early (0.4%) and late spraying (0.8%) with Ca(NO3)2 on storability and the calcium content as well as elemental mutual relations in 'Elise' fruit of a 5-year-old apple tree were studied. Trees were sprayed 3 times at 10-day intervals in the first time of fruit development (beginning of June) and 30 days before fruit harvest. Fruit mineral composition was estimated after harvest. Foliar sprayings with calcium before harvesting (30 days before) significantly increased the Ca concentration in apples in both years of the experiment. This dependence was only slight and observed in the case of early spraying (at the beginning of June). The late foliar treatment with calcium nitrate significantly reduced the N/Ca and K/Ca ratios in fruits. Fruits harvested with Ca(NO3)2 had higher flesh firmness and titratable acidity than the control ones. The use of 0.8% Ca(NO3)2 before fruit harvest reduced the percentage of physiological disorders and fungal diseases. [ABSTRACT FROM AUTHOR]

Abstract Background Although European guidelines advise oral glucose tolerance test (OGTT) in patients with acute myocardial infarction (AMI) before or shortly after hospital discharge, data supporting this recommendation are inconclusive. We aimed to analyze whether disturbances in glucose metabolism diagnosed before hospital discharge in AMI patients represents a latent pre-existing condition or rather temporary finding. Additionally, we planned to investigate the value of pre-selected glycemic control parameters as predictors of long-term glucometabolic state. Methods We assessed admission glycemia, glycated hemoglobin, mean blood glucose concentration on days 1 and 2 in 200 patients with a first AMI but without overt disturbances of glucose metabolism. We also performed OGTT at discharge and 3 months after discharge. Results The prevalence of disturbances in glucose metabolism (as assessed by OGTT) at 3 months was significantly lower than at discharge (29% vs. 48%, p = 0.0001). Disturbances in glucose metabolism were not confirmed in 63% of patients with impaired glucose tolerance and in 36% of patients with diabetes mellitus diagnosed during the acute phase of AMI. Age >77 years, glucose ≥12.06 mmol/l at 120 minutes during OGTT before discharge and mean blood glucose level on day 2 >7.5 mmol/l were identified as independent predictors of disturbances in glucose metabolism at the 3-month follow-up. Conclusions Disturbances in glucose metabolism observed in patients with a first AMI are predominantly transient. Elderly age, high plasma glucose concentration at 120 minutes during OGTT at discharge and elevated mean blood glucose level on day 2 were associated with sustained disturbances in glucose metabolism.

Background: Diabetic cardiomyopathy (DbCM) is characterized by asymptomatic stage B heart failure (SBHF) caused by diabetes-related metabolic alterations. DbCM is associated with an increased risk of progression to overt heart failure (HF). The prevalence of DbCM in patients with type 2 diabetes (T2D) is not well established. This study aims to determine prevalence of DbCM in adult T2D patients in real-world clinical practice., Methods: Retrospective multi-step review of electronic medical records of patients with the diagnosis of T2D who had echocardiogram at UC San Diego Medical Center (UCSD) within 2010-2019 was conducted to identify T2D patients with SBHF. We defined "pure" DbCM when SBHF is associated solely with T2D and "mixed" SBHF when other medical conditions can contribute to SBHF. "Pure" DbCM was diagnosed in T2D patients with echocardiographic demonstration of SBHF defined as left atrial (LA) enlargement (LAE), as evidenced by LA volume index ≥ 34 mL/m 2 , in the presence of left ventricular ejection fraction (LVEF) ≥ 45%, while excluding overt HF and comorbidities that can contribute to SBHF., Results: Of 778,314 UCSD patients in 2010-2019, 45,600 (5.9%) had T2D diagnosis. In this group, 15,182 T2D patients (33.3%) had echocardiogram and, among them, 13,680 (90.1%) had LVEF ≥ 45%. Out of 13,680 patients, 4,790 patients had LAE. Of them, 1,070 patients were excluded due to incomplete data and/or a lack of confirmed T2D according to the American Diabetes Association recommendations. Thus, 3,720 T2D patients with LVEF ≥ 45% and LAE were identified, regardless of HF symptoms. In this group, 1,604 patients (43.1%) had overt HF and were excluded. Thus, 2,116 T2D patients (56.9% of T2D patients with LVEF ≥ 45% and LAE) with asymptomatic SBHF were identified. Out of them, 1,773 patients (83.8%) were diagnosed with "mixed" SBHF due to comorbidities such as hypertension (58%), coronary artery disease (36%), and valvular heart disease (17%). Finally, 343 patients met the diagnostic criteria of "pure" DbCM, which represents 16.2% of T2D patients with SBHF, i.e., at least 2.9% of the entire T2D population in this study., Conclusions: Our findings provide insights into prevalence of DbCM in real-world clinical practice and indicate that DbCM affects a significant portion of T2D patients., (© 2024. The Author(s).)

Purpose: Obstructive sleep apnea (OSA)-related pulmonary hypertension (PH) can often be reversed with treatment of OSA via continuous positive airway pressure. We hypothesized that treatment of OSA would be associated with a greater improvement in exercise capacity (EC) with cardiac rehabilitation (CR), especially in patients with PH as compared with those who are untreated., Methods: We reviewed medical records of 315 consecutive patients who participated in CR. Pulmonary hypertension status was assessed on the basis of peak tricuspid regurgitant velocity (>2.8 m/sec) on pre-CR echocardiograms. The OSA status (no, untreated, or treated OSA) was determined on the basis of results from sleep studies, continuous positive airway pressure device data, and physician notes. Exercise capacity was assessed by measuring metabolic equivalents (METs) using a treadmill stress test before and after CR., Results: We included 290 patients who participated in CR with available echocardiographic data: 44 (15%) had PH, and 102 (35%) had known OSA (30 treated and 72 untreated). Patients with OSA versus those with no OSA were more likely to have PH ( P = .06). Patients with PH versus no-PH were associated with significantly lower baseline METs in crude and adjusted analyses ( P ≤. 004). The PH and OSA status in isolation were not associated with changes in METs ( P > .2) with CR. There was a significant interaction between OSA treatment and PH in crude and adjusted analyses ( P ≤.01): treatment vs no treatment of OSA was associated with a clinically and statistically greater improvement in METs in patients who participated in CR with but not without PH., Conclusion: Baseline PH was associated with decreased baseline EC but did not attenuate CR-related improvements in METs. However, in the subset of OSA patients with PH, OSA therapy was associated with improved EC after CR., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Despite differing underlying pathophysiology, type 1 and type 2 myocardial infarction share many of the same diagnostic criteria and can be challenging to differentiate in clinical practice. Correctly differentiating type 1 from type 2 myocardial infarction is important because they are managed differently. The aim of this study was to compare the patterns of rise of cardiac troponin (cTn) and creatine kinase MB (CK-MB) in type 1 and type 2 myocardial infarction., Methods: We analyzed retrospective data on 200 patients with myocardial infarction (97 with type 1, 103 with type 2), excluding patients with ST-segment elevation myocardial infarction. The percentage rise from trough to peak values and the ratio of the peak to the upper limit of normal (RULN) were calculated for both cardiac troponin T (cTnT) and CK-MB. The ratio of peak cTnT to peak CK-MB was also calculated before and after adjusting for sex, glomerular filtration rate (GFR), and infarct size., Results: Type 1 myocardial infarction tended to be larger than type 2 myocardial infarction, with a significantly higher mean percentage rise for both cTnT and CK-MB as well as higher mean RULN (207 vs 86 for cTnT, P = 0.02; 9 vs 4 for CK-MB, P = 0.002). There was a trend toward a higher rise of cTnT than CK-MB in type 2 compared with type 1 myocardial infarction, as demonstrated by the ratio of peak cTnT to peak CK-MB (0.09 in type 2 myocardial infarction vs 0.06 in type 1 myocardial infarction, P = 0.06). This difference persisted after adjusting for sex, GFR, and infarct size (P = 0.05)., Conclusion: Both cTnT and CK-MB rise higher in type 1 than in type 2 myocardial infarction. Meanwhile, cTnT tends to rise out of proportion to CK-MB in type 2 myocardial infarction. These patterns may have considerable implications for the differentiation and subsequent treatment of patients with type 1 versus type 2 myocardial infarction., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Postural orthostatic tachycardia syndrome (POTS) is a debilitating disease that predominantly affects young women. It is a multifactorial disorder that is characterized by severe tachycardia and orthostatic intolerance. Patients with POTS experience a variety of cardiac, neurological, and immunological symptoms that significantly reduce quality of life. In this review, a comprehensive framework is provided to aid in helping identify and treat patients with POTS. Given its heterogenous nature, it is crucial to understand each component of POTS in relation to one another instead of distinct parts. The framework highlights the overlap among the five main subtypes of POTS based on its pathophysiology (neuropathic, hypovolemic, primary hyperadrenergic, joint-hypermobility-related, and immune-related). Emphasis is placed on incorporating a multidisciplinary approach when treating patients with POTS, especially with a new focus towards immunotherapy. Although research has advanced our knowledge of POTS, there is still a critically unmet need to further our understanding and provide patients with the relief they need.

Acute myocardial infarction (MI) provokes a systemic inflammatory response that may contribute to the development of left ventricular systolic dysfunction (LVSD) and heart failure (HF). Patients with post-infarct HF with concomitant LVSD have the most unfavourable long-term prognosis. Measurement of C-reactive protein (CRP) concentration reflecting an involvement of inflammatory pathways in post-infarct myocardial damage offers an attractive strategy to improve risk stratification and clinical decision-making for early management of high-risk patients. Despite growing evidence for the prognostic value of CRP both as a single factor and as a component of multi-marker approach in MI, CRP measurement is not yet incorporated into current guidelines. This may be due to conflicting results reported in existing studies related to various limitations in study designs, such as retrospective case control design, prior myocardial damage, CRP measurement with low-sensitivity assays, non-homogenous populations with acute coronary syndromes, different treatment strategies, small sample sizes, and the lack of left ventricular ejection fraction assessment and long-term clinical and echocardiographic monitoring. As a result, previous studies have not provided conclusive evidence of the prognostic value of CRP for post-infarct LVSD or HF. Future studies with an adequate design including upstream mediators of inflammation as inflammatory markers are needed to identify the best biomarker-based strategies for identifying high-risk patients. Further clinical trials involving anti-inflammatory therapies target-ing different pathways of inflammatory activation in MI should test the inflammatory hypothesis of post-infarct LVSD and HF. Identifying high-risk patients with persistent post-infarct inflammatory response may allow incorporation of pathophysiological guidance for implementation of personalised treatment approaches.

Recent reports indicate that statins are associated with an increased risk for new-onset diabetes mellitus (DM) compared with placebo and that this relation is dose dependent. The aim of this study was to perform a comprehensive network meta-analysis of randomized controlled trials (RCTs) investigating the impact of different types and doses of statins on new-onset DM. RCTs comparing different types and doses of statins with placebo were searched for using the MEDLINE, Embase, and Cochrane databases. A search of RCTs pertinent to this meta-analysis covering the period from November 1994 to October 2012 was conducted by 2 independent investigators using the MEDLINE, Cochrane, Google Scholar, and Embase databases as well as abstracts and presentations from major cardiovascular meetings. Seventeen RCTs reporting the incidence of new-onset DM during statin treatment and including a total of 113,394 patients were identified. The RCTs compared either a statin versus placebo or high-dose versus moderate-dose statin therapy. Among different statins, pravastatin 40 mg/day was associated with the lowest risk for new-onset DM compared with placebo (odds ratio 1.07, 95% credible interval 0.86 to 1.30). Conversely, rosuvastatin 20 mg/day was numerically associated with 25% increased risk for DM compared with placebo (odds ratio 1.25, 95% credible interval 0.82 to 1.90). The impact on DM appeared to be intermediate with atorvastatin 80 mg/day compared with placebo (odds ratio 1.15, 95% credible interval 0.90 to 1.50). These findings were replicated at moderate doses. In conclusion, different types and doses of statins show different potential to increase the incidence of DM., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge., Materials and Methods: Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24 h after admission and at discharge with an ultra-sensitive latex immunoassay., Results: CRP concentration increased significantly during the first 24 h of hospitalization (2.4 ± 1.9 vs. 15.7 ± 17.0 mg/L; p < 0.001) and persisted elevated at discharge (14.7 ± 14.7 mg/L), mainly in 57 patients with LVSD (2.4 ± 1.8 vs. 25.0 ± 23.4 mg/L; p < 0.001; CRP at discharge 21.9 ± 18.6 mg/L). The prevalence of LVSD was significantly increased across increasing tertiles of CRP concentration both at 24 h after admission (13.2 vs. 19.1 vs. 51.5 %; p < 0.0001) and at discharge (14.7 vs. 23.5 vs. 45.6 %; p < 0.0001). Multivariate analysis demonstrated CRP concentration at discharge to be an independent marker of early LVSD (odds ratio of 1.38 for a 10 mg/L increase, 95 % confidence interval 1.01-1.87; p < 0.04)., Conclusion: Measurement of CRP plasma concentration at discharge may be useful as a marker of early LVSD in patients after a first STEMI.

Objective: To assess the value of C-reactive protein (CRP) in predicting postinfarct left ventricular remodelling (LVR)., Methods: We measured in-hospital plasma CRP concentrations in patients with a first ST-segment elevation myocardial infarction (STEMI)., Results: LVR was present at 6 months in 27.8% of 198 patients. CRP concentration rose during the first 24 h, mainly in LVR group. The prevalence of LVR was higher in patients from the highest quartile of CRP concentrations at 24 h as compared to those from any other quartile (odds ratio (OR) 3.48, 95% confidence interval (95% CI) 1.76-6.88). Multivariate analysis identified CRP concentration at 24 h (OR for a 10 mg/L increase 1.29, 95% CI 1.04-1.60), B-type natriuretic peptide at discharge (OR for a 100 pg/mL increase 1.21, 95% CI 1.05-1.39), body mass index (OR for a 1 kg/m(2) increase 1.10, 95% CI 1.01-1.21), and left ventricular end-diastolic volume (OR for a 1 mL increase 0.98, 95% CI 0.96-0.99) as independent predictors of LVR. The ROC analysis revealed a limited discriminative value of CRP (area under the curve 0.61; 95% CI 0.54-0.68) in terms of LVR prediction., Conclusions: Measurement of CRP concentration at 24 h after admission possesses a significant but modest value in predicting LVR after a first STEMI.

Paravalvular leak (PVL) is a complication observed in patients after prosthetic valve replacement. The incidence of PVL is estimated as 2-3%. The cause of PVL may be paravalvular infection, suture continuity disruption, damage of tissues around the annulus or limitation of disc mobility by thrombus or vegetation. The preferable method of treatment of PVL is surgery. Recently, percutaneous closure of PVL became an alternative method. We present a case of successfully completed percutaneous closure of PVL with the use of Amplatzer occluder device in a patient with mitral PVL.

We present a case of a male patient who was admitted to the cardiology department with a diagnosis of NSTEMI (deep negative T waves in all precordial leads). Two weeks earlier he was hospitalised because of a stroke caused by thrombosis of the left carotid artery. He had no angina. An ECHO showed a normal myocardial contractility of the left ventricle. The concentration of troponin I was also normal. No coronary artery stenosis was revealed in coronary angiography. We present a review of studies devoted to ECG changes in patients with stroke.

Background: Many observational and randomised studies have suggested that women are referred for invasive diagnostics and treatment of coronary artery disease (CAD) less frequently than men, and the effects of percutaneous coronary intervention (PCI) among women are worse than in men., Aim: To compare direct results of PCI in men and women., Methods: The study was a retrospective assessment of case records of one thousand consecutive patients treated with PCI because of acute myocardial infarction (AMI) (344 patients), unstable angina (UA) (164 patients) and stable angina (SA) (492 patients). We examined the effects of demographic, angiographic and clinical variables on the duration of hospitalisation and in-hospital mortality separately in men and in women., Results: Women constituted 30.7% of patients treated with PCI because of AMI, 39.6% of those with UA and just 25.8% of those with SA. Women were significantly older than men, had a higher BMI, and more often suffered from hypertension and diabetes. The duration of hospitalisation was the same in men and women if the reason for PCI was SA or UA, however, in case of AMI women were hospitalised significantly longer than men. In the univariate analysis gender had no influence on in-hospital mortality regardless of the reason for PCI treatment. Among the variables subjected to multivariate analysis female gender, age, BMI, diabetes, hypercholesterolaemia, indication for PCI, final TIMI flow in the target vessel and cardiogenic shock as a complication of AMI were shown to affect mortality. Significant effects on in-hospital mortality for women were exhibited only by cardiogenic shock. Among men, indication for PCI, age, diabetes and final TIMI flow in the target vessel also had a significant influence on in-hospital mortality., Conclusions: Stable angina is a reason for performing PCI more rarely in women than in men. Women with CAD are older than men and have more risk factors. The in-hospital mortality among patients treated with PCI because of SA is independent of gender. Cardiogenic shock appeared to be the only factor that influences in-hospital mortality in women. In the case of men such an influence is also observed for indication for PCI (AMI, UA or SA), diabetes and final TIMI flow in the target vessel.

Background: The purpose of this study was to compare risk predicted using available risk scores and actual outcomes in patients with left main coronary artery disease undergoing percutaneous coronary intervention with stent implantation (PCI LM)., Methods: We studied 204 patients treated with elective or emergent coronary angioplasty. We estimated in-hospital mortality using the EuroSCORE, Parsonnet and GRACE risk scores and compared this data with actual in-hospital mortality., Results: There were no deaths among 62 patients undergoing elective PCI LM regardless of the estimated risk. Acute coronary syndrome (ACS) was diagnosed in all 142 patients undergoing emergent PCI LM. Mortality in this group was 24% (34/142). Area under receiver operating characteristic curve (AUC) values for the EuroSCORE, Parsonnet and GRACE risk scores in patients with ACS were 0.812 (p = 0.0001), 0.857 (p = 0.0001), and 0.870 (p = 0.0001), respectively. No statistically significant differences were found when these AUC values for different evaluated risk scores were compared. Overall, the EuroSCORE and Parsonnet risk scores had no discriminative value, as all deaths occurred in the highest risk group. Only the GRACE risk score discriminated risk among intermediate- and high-risk patients with ACS., Conclusions: The EuroSCORE and Parsonnet scoring systems are of no value in predicting periprocedural mortality risk in patients undergoing elective PCI LM. Overall, discriminative ability of the EuroSCORE, Parsonnet, and GRACE risk scores in unselected patients with ACS undergoing emergent PCI LM was good. In this group of patients, the EuroSCORE and Parsonnet scoring systems had no discriminative value in low and moderate risk patients. Only the GRACE risk score discriminated risk among intermediate and high risk patients.

Background: The purpose of the study was to assess the effect of trimetazidine administered for 20 days in 56 patients with ischemic heart disease treated with maximal tolerated doses of anti-ischemic drugs who were not candidates for percutaneous or surgical revascularization., Methods: The efficacy of trimetazidine was evaluated by comparing exercise testing parameters before and after treatment, combined with the patient response to a questionnaire administered at baseline and following the treatment. We evaluated the duration of exercise, workload, double product, time to the occurrence of ischemic changes in ECG, the number of leads with diagnostic ST segment depression, and the magnitude of ST segment depression., Results: After 20 days of trimetazidine treatment, an improvement in exercise testing parameters was seen in about 50% of patients, and the differences of the mean values were statistically significant. The patient response to the questionnaire administered following the treatment indicated a decreased frequency of anginal episodes and an increased exercise duration to the occurrence of angina in two thirds of patients, less requirement for nitrates in 40% of patients, and increased exercise tolerance in 50% of patients. In patients with subjective response to treatment, comparison of exercise testing parameters before and after treatment showed significant increase in the duration of exercise, time to ischemic changes in ECG, and the degree of ST segment depression during peak exercise. In patients with no subjective response to treatment, a statistically significant difference was seen in the double product only., Conclusions: After 20 days of treatment with trimetazidine added to maximal anti-ischemic treatment in patients with refractory angina, an improvement in exercise testing parameters and subjective response to treatment were seen in about 40% of patients. In patients with subjective response to treatment, exercise testing parameters improved significantly compared to the baseline values.

Iatrogenic perimembranous ventricular septal defect is a rare complication after surgical replacement of the aortic valve, and so transcatheter closure of such a defect is not a routine procedure. We report the successful closure of an iatrogenic perimembranous ventricular septal defect which occurred after the replacement of the aortic valve and ascending aorta.

Background: Numerous trials have reported on the morning increase in the occurrence of myocardial infarction, stroke and sudden cardiac death. Similarly, enhanced morning platelet aggregation has been observed in healthy individuals and in subjects with coronary artery disease without adequate antiplatelet treatment. The purpose of the study was to assess circadian variation in platelet aggregation in patients with first ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (pPCI) and dual antiplatelet therapy., Methods: Fifteen consecutive patients (12 men and 3 women) were prospectively recruited into the study. Blood samples were collected at 6.00 a.m., 10.00 a.m., 2.00 p.m. and 7.00 p.m. on the third day of hospitalization. Aggregation in response to arachidonic acid and adenosine diphosphate (ADP) was assessed in the whole blood on a new generation impedance aggregometer., Results: A morning increase of 75% in ADP-dependent platelet aggregation was noted in the study population (p < 0.04). In contrast, we failed to show any significant diurnal variation in arachidonic acid-mediated platelet aggregation. The magnitude of the morning surge in platelet aggregation after ADP stimulation did not correlate with its baseline level., Conclusions: Increased morning ADP-dependent platelet aggregation persists despite dual antiplatelet therapy in patients with first STEMI undergoing pPCI. The clinical significance of this finding remains to be demonstrated.

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.

Unlabelled: A prospective collection of clinical (history), electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. All patients (65% male) without prior history of myocardial infarction undergone clinical evaluation: chest pain classification according to Diamond, ECG, EE (regarded as positive on the basis of > or = 1 mm ST-depression), SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA):CAD was defined as > or = 50% narrowing of at least one major vessel. Sensitivity and specificity of ECG, EE, SE was calculated: and results are as follows respectively: 23% and 87%, 93% and 21%, 85% and 69%. On the basis of these results with implication of probability analysis two algorithms were developed by computer program. They incorporated pretest variables: age, gender, chest pain classification, ECG and results of one or two non-invasive tests: EE and (or) SE. The sensitivity and specificity of the algorithm is 96% and 44%., Conclusions: 1. Chest pain characteristics remains an effective tool for estimating probability of CAD. 2. The diagnostic value of resting electrocardiography in stable CAD is low. 3. SE has comparably sensitivity but significantly higher specificity than EE. 4. We demonstrated that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA. 5. When the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).

Unlabelled: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. 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., Results: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%., Conclusion: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

The DNA ploidy status of 186 fresh primary breast tumors was analyzed in a comparative study of flow cytometric (FCM) and image (IA) analyses. Tumor size, histology and nodal status were also taken into account. The same piece of fresh tissue was used for touch imprints (IA) and for DNA analysis by FCM. Both methods provided concordant DI values in 158 (85%) tumors (r = 0.7490). The tumor grade and lymph node status significantly correlate with ploidy estimated by FCM and IA. We conclude that FCM and IA provide comparable results of DNA content although occasional discrepancies occur. IA seems to be a more sensitive method especially for diploid cases detected by FCM.

Objective: The aim of the research was to demonstrate that the early diagnosis of infective endocarditis influences significantly the results of treatment., Methods: The following clinical analysis covered 56 patients, aged 18 to 81 (the average age--50 years) with infective endocarditis treated in the years 1998-2000. Data from patient history, physical examination, laboratory investigations and treatment were analysed. Apart from clinical symptoms for infective endocarditis diagnosis, also blood cultures and echocardiography were important., Main Observations: Infective endocarditis was present in 24 patients (42.8%) with heart defects, 7 (12.5%) with prosthetic heart valves, and 4 (7.1%) treated with haemodialysis., Results: In 38 (67.8%) individuals, the echocardiography showed vegetations, and in 14 (25.0%) other abnormalities. Blood cultures were positive in 33 (58.9%) patients. Fever was present in 47 (83.9%) patients. The progression of heart failure appeared in 26 (46.4%) individuals. The average time of antibiotic therapy was 34 days. 11 (19.6%) patients died. 9 (16.1%) individuals had cardiosurgery operations., Conclusions: Early diagnosis of infective endocarditis is substantial as it improves patients' prognosis as to health and life.

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.

A group of 350 unselected breast cancer patients, treated at the Center of Oncology in Cracow, Poland, between January 1992 and December 1994, was analyzed. The following reciprocally interrelated histologic characteristics were evaluated: 1) histologic tumor type (considered in 3 categories of aggressivity), 2) tumor grade (according to Scarf-Bloom-Richardson), 3) constituent of in-situ carcinoma in invasive cancers and characterization of breast lobuli, 4) tumor growth pattern (microfocal, macrofocal or mixed), 5) invasion of nerves, 6) vascular invasion by cancer cells in tumor surroundings, 7) extensiveness of tumor necrosis, 8) involvement of the breast distant from the tumor mass by cancer cells, 9) status of axillary lymph nodes, 10) invasion of metastatic lymph node surroundings. Metastases in axillary lymph nodes were independently influenced by vascular invasion in tumor surroundings and tumor diameter. The disease-free survival was independently influenced by tumor diameter, necrosis and stage of the disease (pTNM), whereas total survival related to tumor diameter, nodal status, microfocal pattern of tumor growth, vascular invasion and involvement of breast by cancer distant from the tumor mass was independently influenced only by tumor stage (pTNM).

Clinicopathologic parameters of 70 consecutive mesenchymal tumors from 63 patients were evaluated. In all these cases, the DNA content was analyzed by flow cytometry, and the expression of proliferative antigen MIB1 and p53 protein was assessed by immunohistochemistry. Our study verified the prognostic usefulness of proliferative indicators, above all MIB1-index, which strongly correlated with tumor grade and independently influenced overall survival.

In the group of forty five primary mammary carcinomas Ki67 reactivity was evaluated with flow cytometry and immunohistochemistry. The expression of proliferative antigen, evaluated with both methods did not correlate with other indicators of proliferative activity. This result is probably associated with the physicochemical properties of breast cancer cells.

Based upon a group of 108 consecutive mammary carcinomas a comparative analysis of morphological parameters, DNA-ploidy and indicators of proliferation activity was made. A correlation between Bloom-Richardson scale, mitotic index, PCNA-labeling index and DNA-index was shown. The ploidy of mammary carcinomas was significantly related to the values of proliferative fraction, as well as to PCNA-labeling index. Among patients with axillary metastases the tumor size and the value of PCNA-labeling index were significantly higher than those in patients with negative lymph nodes.

The results of flow cytometric DNA-analysis on fresh and paraffin-embedded tissue were compared in four various groups of tumors. The best correlation of the results was observed in the group of non Hodgkin's lymphomas. Comparative analysis of the ploidy on fresh and paraffin embedded tissue demonstrated discordance in particular in mammary carcinoma and malignant melanoma groups. The values of proliferative fraction assessed on fresh and paraffin embedded tissues were interrelated.