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1. Effect of Sibutramine on Cardiovascular Outcomes in Overweight and Obese Subjects

Author

James, Wp, Caterson, Id, Coutinho, W, Finer, N, VAN GAAL LF, Maggioni, Ap, TORP-PEDERSEN, C, Sharma, Am, Shepherd, Gm, Rode, Ra, Renz, Cl, Van Gaal LF, Torp-Pedersen, C, Pepine, C, Pocock, S, Drexler, H, Swedberg, K, Sleight, P, Armstrong, P, Kerr, D, Dagenais, G, Brophy, J, Avezum, A, Bogaty, P, Fabbri, G, Galli, M, Hildebrandt, P, Mann, J, Ostergren, J, Sherman, D, Zannad, F, Colquhoun, D, Hollanders, G, e Forti A, Costa, Cifkova, R, Toubro, S, Ziegler, O, Scherbaum, Wa, Jordan, J, Halmy, L, Ferrannini, E, Santini, F, Gonzalez, C, Narkiewicz, K, Hancu, N, Payer, J, Pascual, J, Wilding, J, Campbell, L, Carey, D, Gerstman, M, Karrasch, J, Lefkovits, J, Marks, J, Marks, S, Moses, R, Phillips, P, Proietto, J, Roberts, D, Roberts-Thomson, P, Shaw, J, Simpson, R, Singh, B, Singleton Jeffries, W, Stuckey, B, Boland, J, Brohet, C, Coucke, F, Dendale, P, Jouret, G, Kolanowski, J, Kutnowski, M, Martens, F, Muls, E, Peiffer, F, Penninckx, H, Scheen, A, Schoors, D, Vaerenberg, M, Van Cleemput, J, Van Crombrugge, P, Van Kuyk, M, Verhaegen, A, Wollaert, B, de Albuquerque DC, Appolinario, J, de Godoy Matos AF, Gross, Jl, Halpern, A, Kerr Saraiva JF, Milagres, R, Repetto, G, Suplicy, Hl, Zanella, Mt, Bednarova, J, Cepelak, V, Cerny, P, Hainer, V, Havranek, P, Homza, M, Jansa, P, Karlicek, M, Kolesar, J, Kotik, I, Kucera, D, Kuchar, J, Kunc, M, Kvapil, M, Linhart, A, Machova, V, Matuska, J, Oral, I, Pavlas, J, Pesatova, S, Povolny, J, Semrad, B, Smetana, K, Soucek, M, Svacina, S, Tesinsky, P, Urbanek, R, Wasserburger, B, Zachoval, R, Zahumensky, E, Zidkova, E, Astrup, A, Dominguez, H, Faber, J, Hilderbrant, P, Kober, L, Perrild, H, Richelsen, B, Sogaard, P, Svendsen, Ol, Urhammer, S, Archambeaud, F, Basdevant, A, Borys, Jm, Bringer, J, Brunetiere, C, Charpentier, G, Cocaul-André, M, Dabadie, H, Dubreuil, A, Estour, B, Gautier, Jf, Gibault, T, Halimi, S, Hespel, Jp, Issa Sayegh, M, Krempf, M, Laville, M, Lecerf, Jm, Louvet, Jp, Penfornis, A, Ritz, P, Schlienger, Jl, Schmitt, B, Valensi, P, Baar, M, Beermann, J, Bock, M, Boenner, G, Dammann, Hg, Diehm, C, Ditschuneit, H, Gadow, J, Gehlhar, S, Gessner, S, Guthersohn, A, Hamann, A, Hanefeld, M, Hasenfuss, G, Herzner, A, Heun, Kc, Heufelder, Ae, Hohensee, H, Jacob, S, Krings, P, Krätzig, B, Krosse, B, Lehmann, Rt, Mindt-Prüfert, S, Maisch, B, Pfeiffer, Af, Richard, F, Rose, B, Schmidt, E, Scholze, J, Schreckenberg, A, Stuebler, P, Walter, J, Wirth, A, Wunderlich, J, Abraham, G, Altorjay, A, Augusztin, G, Csaszar, A, Czuriga, I, Dinnyes, J, Gero, L, Gyimesi, A, Janosi, A, Kovacs, I, Liziczai, I, Majtenyi, A, Medvegy, M, Nadhazi, Z, Pados, G, Polak, G, Ronaszeki, A, Sido, Z, Simon, K, Anzà, C, Bevilacqua, M, Bosello, O, Chiariello, M, Cordera, R, Ferrari, E, Frittitta, L, Giorgino, R, Liuzzi, A, Malinverni, C, Di Mario, U, Melchionda, N, Occhi, G, Perticone, F, Pinchera, A, Pinelli, G, Rovera, G, Santeusanio, F, Urbinati, S, Alpizar-Salazar, M, Carrillo-Ortega, E, Fanghanel Salmon, G, Laviada-Molina, Ha, Madero, Ma, Rodriguez, G, Saldate, C, Sanchez-Castillo, Cp, Violante, Rm, Wacher, N, Zayas-Jaime, Fj, Zuniga-Guajardo, S, Adamiec, R, Banasiak, W, Chrusciel, P, Derlaga, B, Gebala, A, Gessek, J, Janik, K, Janion, M, Kalina, Z, Kozlowski, A, Kusnierz, B, Majcher, Z, Miekus, P, Niegowska, J, Okopien, B, Ostrowska, L, Pasowicz, M, Piepiorka, M, Pluta, W, Polaszewska-Muszynska, M, Ponikowski, P, Pupek-Musialik, D, Sawicki, A, Sobocik, H, Stankiewicz, A, Szpajer, M, Trojnar, R, Tykarski, A, Wrabec, K, Wyrzkowski, B, Zahorska-Markiewicz, B, Zalewski, M, Carrageta, M, Mendes Pedro MM, Parente Martins LM, dos Santos, L, Babes, A, Creteanu, G, Dan, Ga, Dragulescu, Si, Graur, M, Tirgoviste, Ci, Morosanu, M, Mota, M, Paveliu, Fs, Radoi, M, Ranetti, A, Totoian, I, Andre, I, Bugan, V, Cencarik, J, Csala, L, Farsky, S, Gonsorcik, J, Kamensky, G, Kmec, J, Krahulec, B, Kurian, R, Macek, V, Majercak, I, Micko, K, Mokan, M, Riecansky, I, Sojka, G, Uhliar, R, Urgeova, L, Vancik, J, Baro, Fm, Barrios Merino, A, Borras, Jl, Caixas, A, Cuatrecasas Cambra, G, Dominguez Escribano JR, Duran Garcia, S, Escobar-Jimenez, L, Esteva de Antonio, I, Formiguera Sala, X, Garcia-Luna, Pp, Garcia Robles, R, Gonzalez Albarran, O, Hernandez-Mijares, A, Martin Hidalgo, A, Masmiquel Comas, L, Morales Perez, F, Moreno Esteban, B, Pascual Izuel JM, Redon Mas, J, Ricart, W, Rubio, Ma, Ruilope, Lm, Salas-Salvado, J, Terroba Larumbe, M, Tinahones, F, de la Torre Casares ML, Vidal Cortada, J, Zuniga-Perez Lemaur, M, Abdulhakim, Ee, Adler, A, Barnett, Ah, Bodmer, C, Campbell, Iw, Chowdhury, T, Cleland, J, Cook, Rc, Dinneen, S, Donnachie, H, Haslam, Dw, Hillis, Gs, Horne, M, Howarth, Dj, Hughes, E, Jackson, S, Jones, Sc, Jones, Th, Kumar, S, Lean, M, Maroni, J, Mcinnes, G, Middleton, A, Morris, A, Newcombe, G, O'Kane, Kp, Pavel, Ic, Pawa, R, Perry, C, Pitts, C, Raja, A, Reckless, J, Robinson, J, Sarmiento, R, Soo, Sc, Taylor, S, Thomas, Ho, Thomson, Ma, and Wilkins, M.

Subjects
Male, medicine.medical_specialty, Myocardial Infarction, Blood Pressure, Kaplan-Meier Estimate, Type 2 diabetes, Klinikai orvostudományok, Placebo, law.invention, Double-Blind Method, Randomized controlled trial, Weight loss, law, Internal medicine, Appetite Depressants, medicine, Humans, Obesity, Myocardial infarction, Stroke, Aged, business.industry, Hazard ratio, Orvostudományok, General Medicine, Middle Aged, Overweight, medicine.disease, Surgery, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Cardiology, Female, Human medicine, medicine.symptom, business, Cyclobutanes, Sibutramine, medicine.drug
Abstract

Background The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. Methods We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). Results The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. Conclusions Subjects with preexisting cardiovascular conditions who were receiving long-term sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.)

Published
2010

2. Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Author

Bacquet, P, Levy, E, Mcguire, A, Mcmurray, J, Merot, Jl, Paschen, B, Remme, Wj, Szucs, Td, Klein, W, Brunhuber, W, Hofmann, R, Kuhn, P, Nesser, Hj, Slany, J, Weihs, W, Wiedermann, C, Wimmer, H, van Mieghem, W, Boland, J, Chaudron, Jm, Jordaens, L, Melchior, Jp, Aschermann, M, Bruthansl, J, Hradec, M, Kolbel, F, Semrad, B, Haghfelt, T, Hansen, Jf, Goetzsche, Co, Hildebrandt, P, Kassis, E, Rasmussen, V, Rokkedal, J, Thomassen, A, Groundstroem, K, Uusimaa, P, Le Heuzey JY, Aumont, Mc, Aupetit, Jf, Baille, N, Baudouy, P, Belin, A, Bonneau, A, Bonneric, G, Bousser, Jp, Citron, B, Dary, P, Decoulx, E, De Groote, P, Denolle, T, Dievart, F, Duriez, P, Eicher, Jc, Enjuto, G, Ferriere, M, Fournier, E, Garandeau, M, Gauthier, J, Genest, M, Gerbe, A, Godenir, Jp, Guillot, B, Guillot, Jp, Guillot, P, Heno, P, D'Ivernois, C, Jean, M, Kacet, S, Kalle, R, Komajda, M, Lacroix, A, Lallemand, R, Lardoux, H, Marquet, M, Martin, M, Martin, O, Mery, D, Mossaz, R, Mothes, P, Olive, T, Ostorero, M, Paganelli, F, Page, E, Pauly Laubry, C, Puel, J, Rousseau, Jf, Roux, Jj, Schenowitz, A, Sourdais, K, Tremel, F, Verdun, A, Witchiz, S, Wolf, Je, Hombach, V, Assmann, I, Beyer, T, Bischoff, Ko, Darius, H, Ertl, G, Fleck, E, Forster, K, Freytag, F, Gleichmann, U, Haasis, R, Henssge, R, Hey, D, Hesse, P, Hofs, T, Keck, M, Klein, H, Kromer, Et, Kruls Munch, J, Luderitz, B, Maisch, B, Mitrovic, V, Neubauer, S, Osterziel, Kj, Simon, H, Spitzer, Sg, Stohring, R, Taubert, G, Teichmann, W, Theisen, K, Wende, W, Wieser, H, Zotz, R, Bridges, A, Adgey, J, Ambepitiya, G, Boon, N, Boyle, Rm, Cowley, Aj, Cripps, T, Davies, Mk, Dunn, F, Findlay, J, Forsey, P, Fyfe, T, Gould, B, Greenwood, Tw, Hubner, P, Khan, S, Lewis, P, Mackay, A, Maltz, M, Mcarthur, J, Mcleod, A, Mcleod, D, Metcalfe, M, Millar Craig, M, Mills, P, Nelson, Jk, Nicholls, D, Oakley, Gd, Patterson, Dlh, Pohl, Jef, Ray, S, Silke, B, Wilkinson, Pr, Preda, I, Csanady, M, Cserhalmi, L, Edes, I, Gesztesi, T, Karpati, P, Simon, K, Tarjan, J, Fogari, R, Tramarin, R, Galie, N, Giani, P, Milanese, U, Scalvini, S, Scrutinio, D, Sechi, Leonardo Alberto, Tettamanti, F, De Vito, F, Crean, P, Mccann, H, Mulcahy, D, Sugrue, D, van Hoogenhuyze DCA, van der Burgh PH, Ciampricotti, R, van Dantzig JM, Denhartog, Fr, Henneman, Ja, van Kesteren HAM, Kragten, Ja, Liem, Kl, Limburg, A, van der Linde MR, Linssen, Gcm, Pasteuning, H, Penn, Hjam, Van Rossum, P, Schaafsma, Hj, Schelling, A, Sloos, R, Wesdorp, Jcl, Korewicki, J, Achremczyk, P, Czestockowska, E, Dowgird, M, Dyduszynski, A, Gorski, J, Ilmurzynska, K, Janicki, K, Kornacewicz Jach, Z, Kraska, T, Krzeminska Pakula, M, Kuch, J, Nartowicz, E, Petelenz, T, Piwowarska, W, Rawczynska Englert, I, Ruzyllo, W, Swiatecka, G, Tendera, M, Wierzchowiecki, M, Wodniecki, J, Wojciechowoski, D, Wrabec, K, Wysocki, H, Gomes, Rs, Ceia, Mf, Lousada, N, Campos, Jmm, Providencia, La, de Moura ALZC, Marejev, Vj, Aronov, Dm, Arutjunov, Gp, Bart, Bj, Basechikin, Ss, Belenkov, Jn, Beloussov, Jb, Bokeria, Oa, Charchogljan, Ra, Doschytsin, V, Fedorova, Ta, Glezer, Mg, Gorbachenkov, A, Gorshkov, Gospodarenko, Al, Ivashkin, Vt, Ivleva, Aj, Kyrichenko, Aa, Lavrov, Aa, Lazebnik, Lb, Marynov, A, Mazaev, Vp, Polejev, Nr, Shpektor, Sidorenko, Ba, Sobolev, Ke, Starodoubtsev, Ak, Storozhakhov, Gi, Syrkin, Al, Zodionchenko, Vs, Zvereva, Tv, Murin, J, Kaliska, G, Rybar, R, Valle, V, Artaza, M, Conthe, P, Cruz, Jm, Garcia Moll, M, Lopez Sendon JL, Martinez, A, Monzon, F, Ribas, M, Roig, E, Roldan, I, Hoglund, C, Ekdahl, S, Hjelmaeus, L, Lindberg, K, Lofdahl, P, Ulvenstam, G, Warselius, L, Follath, F, Anghern, W, Dubach, P, Erne, P, Gallino, A, Moccetti, T, Jmouro, Av, Dargie, Hj, Erdmann, E, Lechat, P, Sendon, Jll, Mareyev, V, Sadowski, Z, Seabra Gomes RJ, Zannad, F, Wehrlen Grandjean, M, Funck Brentano, C, Hansen, S, Hohnloser, S, Vanoli, E, Jaillon, P, De Baker, G, Dahlstrom, U, Hill, C, Leizorovicz, A, Burgnard, F, Rolland, C, Wiemann, H, Verkenne, P, Arab, T, Cussac, N, Dussous, V, Haise, S, and Funck Brentano, C.

Subjects
H Social Sciences (General), medicine.medical_specialty, Cost-Benefit Analysis, Adrenergic beta-Antagonists, METOPROLOL, Placebo, THERAPY, Indirect costs, Pharmacoeconomics, Pharmacotherapy, RANDOMIZED INTERVENTION TRIAL, PHARMACOECONOMICS, Germany, Health care, Bisoprolol, Humans, Medicine, Outpatient clinic, Prospective Studies, Intensive care medicine, health care economics and organizations, Heart Failure, CARVEDILOL, business.industry, MORTALITY, Diagnosis-related group, United Kingdom, Chemotherapy, Adjuvant, MERIT-HF, HOSPITALIZATION, MINIMIZATION, INHIBITORS, France, Quality-Adjusted Life Years, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure.

Published
2001

3. Intravenous NPA for the treatment of infarcting myocardium early; InTIME-II, a double-blind comparison of single-bolus lanoteplase vs accelerated alteplase for the treatment of patients with acute myocardial infarction

Author

Braunwald, E., Neuhaus, K. -L., Antman, E., Chew, P., Skene, A., Wilcox, R., Ambrosioni, E., Anderson, J., Apetrei, E., Bata, I., Carrageta, M., Col, J., Dalby, A., Davies, R., Deckers, J., Eichman, D., Grande, P., Greene, R., Gurfinkel, E., Heikkilä, J., Henry, T., Hillis, D., Hochman, J., Huber, K., Kostis, J., Klinke, P., López-Sendón, J., Mckendall, G., Móller, B., Moore, P., Morris, A., Mueller, H., Östör, E., Oto, A., Ruda, M., Sadowski, Z., Schweiger, M., Sequeira, R., Shah, P., Shannon, R., Smith, B., Sobel, B., Steingart, R., Tebbe, U., Toman, J., Traboulsi, M., Vahanian, A., Warnica, J. W., Willerson, J., Deitchman, D., Davidson, L., Folgia, T., Foxley, A., Goodman, J., Hauck, C., Henry, D., Mccabe, C., Pangerl, A., Thomson, A., Wagner, M., Kennedy, J. W., Cairns, J., Demets, D., Julian, D., Simoons, M., Charlesworth, A., Easton, J. D., Ferbert, A., Feske, S., Kuhn, P., Moseley, J., Rogg, J. M., Reichmann, H., Sloan, M., von Kummer, R., Zamani, A., Coulter, S., Giugliano, R., Skene, A. M., Ardill, R., Ince, Y., Peters, A., Ward, K., Wolf, L., Curtis, N., De Brés, J., Stead, S., Watson, S., Cutler, S., Friedman, J., Helfrick, R., Williams, S., Klimovsky, J., Kumagai, S., Adams, E., Anderson, C., Bauhuber, I., Bennett, L., Biro, E., Boyce, E., Bregman, B., Carvalho, P., Ciganovic, D., Csukas, M., Cuenca, P., De Cuyper, S., Diez, P., Dijkhuizen, M., Dille-Amo, C., Gonzalez-Santis, A., Gursoy, M., Hammarstrom, K., Harasta, E., Ingman, E., Kelemen, B., Keulen, I., Koren, A., Langthaler, G., Lemaire, F., Little, I., Montalban, C., Nijssen, K., Neumueller, I., Palander, M., Pekuri, T., Persson, U., Pilz, J., Oudotova, S., Pisklakov, V., Proinov, F., Ptaszynska, A., Read, J., Retei, S., Romeyer, F., Romanini, M., Saar, L., Salein, D., Samsonov, M., Simeon-Dubach, D., Simmonds, J., Skaza, M., Skvortsova, N., Smidlova, Z., Spitzerova, H., Strijdveen, I., Szajewski, T., Ugurnal, B., Valcarce, M., van Rompaey, I., Walker, A., Zak, E., Zimova, N., Barrero, C., Beck, E., Bruno, M. L., Caccavo, A., Cagide, A., Campo, A., Cermesoni, R., Chahin, M., Dutra, O., Estrada, J., Falu, E. A., Gagliardi, J., Garre, L. E., Liprandi, A. S., Luciardi, H., Mautner, B., Muntaner, J., Nau, G., Salzberg, S., Santopinto, J., Sinisi, A., Torres, H., Eber, B., Elliott, P., Hiemetsberger, H., Juhasz, M., Kühn, P., Leisch, F., Niktardjam, M., Reisinger, J., Schmalix, G., Schuster, R., Sihorsch, K., Silberhauer, K., Slany, J., Steinbach, K., Tragl, K. H., Valentin, A., Al Shwafi, K., Dasnoy, P., De Clippel, M., de Meester, A., De Raedt, H. J. L. P., Emonts, M., Evrard, P., Eycken, M., Geboers, M., Heyndrickx, G., Lauwers, K., Mitrie, K., Pirenne, B., Renard, M., Somers, Y., Timmermans, P., Van Kuyk, M., Van Mieghem, W., Vermeulen, J., Verrostte, J. M., Albuquerque, D., Ayoub, J. C. A., Carvalho, A., Cesar, L., Gebara, O., Golin, V., Knobel, E., Leaes, P., Neto, J. A. M., Nicolau, J. C., Piegas, L. S., Rabelo, A., Rassi, A., Sila, L., Simao, A. F., Ashton, T., Baillie, H., Bhargava, R., Bota, G., Cameron, W., Chan, N., Chan, Y. K., Daly, P. A., Darcel, I., Davies, E., Desjardin, L., Dhingra, S., Ducas, J., Ervin, F. L., Fortin, C., Fowlis, R., Fulop, J., Furey, M., Gagnon, S., Gebhardt, V., Giannaccro, P., Gosselin, G., Graham, J., Grondin, F., Heath, J. W., Henderson, M., Hilton, D. R., Hiscock, J., Hui, W., Kaza, L., Kesselman, T., Kouz, S., Kucerak, M., Lahoude, N., Lamothe, M., Lebouthillier, P., Lenis, J., Levesque, P., Lopez, J. F., Lubelsky, B., Macritchie, D., Mayer, J. -P., Mcdowell, J. D., Montigny, M., Orestien-Lyall, T., Parekh, P., Pistawka, K., Price, J. B., Pruneau, G., Quinn, B., Reid, B. R., Richmond, M., Rose, B., Schuld, R., Sharma, N. K., Shetty, P., Stanton, E., Strauss, H. D., Sussex, B., Theroux, P., Turabian, M., Turner, C., Vizel, S., Walker, M., Weeks, A., Winkler, L., Zacharias, G., Zimmerman, R., Bartolucci, J., Castro, P., Diaz, M. A., Illanes, G., Potthoff, S., Sanchez, E. C., Silva, L. M., Yovanovich, J., Zanetti, F. L., Alan, D., Balázová, K., Boček, P., Cerny, J., Fischerova, B., Holub, M., Hradec, J., Janota, T., Janský, P., Kasper, J., Klimsa, Z., Motovská, Z., Pleva, L., Pluhacek, L., Pšenčka, M., Semrád, B., Spinar, J., Staněk, V., Štípal, R., Suítil, P., Vítovec, J., Wichterie, D., Widimský, P., Zeman, K., Andersen, C. B., Kriegbaum, J., Nielsen, N., Nielsen, P. E., Schou, J. B., Teesalu, R., Voitk, J., Haapamäki, H. V. H., Halkosaari, M., Härkönen, M., Jägerholm, S., Kärjä-Koskenkari, P., Karthunen, P., Kesäniemi, Y. A., Koskivirta, H., Lehto, P., Lilja, M., Paakkinen, S., Palomäki, A. K., Pietilä, K., Tuominen, J., Viopio-Pulkki, L., Ylönen, H., Adi, I., Admant, P., Akadirik, A., Alagha, Z., Alhabaj, S., Amat, G., Andre, A. A., Apffel, F., Aswad, K., Baradat, G., Bareiss, P., Barthers, F. B., Baudet, M., Baudouy, M., Bearez, E. M., Berthou, J. D., Berzin, B., Bessede, G., Blanc, J. J., Bocara, A., Bonneau, A., Bourdad, C., Bouvier, J. 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E., Kozan, O., Kumbasar, D., Muderrisoglu, H., Nisanci, Y., Ozin, B., Ozsaruhan, O., Payzin, S., Postaci, N., Sozcuer, H., Tamci, B., Topuzoglu, F., Türkoglu, C., Tutar, E., Ulucam, M., Ulusoy, T., Umman, B., Yalçinkaya, S., Yesil, M., Zoghi, M., Adams, P. C., Ahir, S., Ahsan, A. J., Akhtar, J., Albers, C. J., Al-Khafaji, M. N., Anderson, N., Bailey, R. J., Bain, R. J. I., Basu, A., Beal, A., Boyle, R. M., Brown, N., Campbell, S., Card, D., Cross, S. J., Davies, P., Davis, E. T. L., Dean, J. W., Deaner, A., Devine, M. A., Dhawan, J., Doig, J. C., Dubrey, S., Dunn, P. G., Dwight, J., Ecob, R., Fitzpatrick, H., Fletcher, S., Francis, C. M., Gershlick, A. H., Glennon, P. E., Goodfield, N. E., Grabau, W. J., Gray, M., Gray, K. E., Heath, J., Hendry, W. G., Highland, J., Hogg, K., Irving, J. B., James, M. A., Jennings, K., Joy, M., Kadr, H. H., Kahn, S., Keeling, P. J., Keir, P. M., Kemp, T. M., Kinaird, J., Kinsey, C., Knowles, K., Kooner, J. 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Subjects
Male, Risk, Infusions, medicine.medical_treatment, Myocardial Infarction, Bolus lytic therapy, Acute myocardial infarction, Tissue plasminogen activator, Thrombolytic drug, Double-Blind Method, Fibrinolytic Agents, medicine, Humans, Thrombolytic Therapy, Myocardial infarction, Infusions, Intravenous, Stroke, Aged, business.industry, ST elevation, Lanoteplase, Emergency department, Middle Aged, medicine.disease, Survival Analysis, Regimen, Relative risk, Anesthesia, Tissue Plasminogen Activator, Female, Intracranial Hemorrhages, Cardiology and Cardiovascular Medicine, business, Intravenous, medicine.drug
Abstract

AIMS To compare the efficacy and safety of lanoteplase, a single-bolus thrombolytic drug derived from alteplase tissue plasminogen activator, with the established accelerated alteplase regimen in patients presenting within 6 h of onset of ST elevation acute myocardial infarction. METHODS AND RESULTS 15,078 patients were recruited from 855 hospitals worldwide and randomized in a 2:1 ratio to receive either lanoteplase 120 KU. kg(-1)as a single intravenous bolus, or up to 100 mg accelerated alteplase given over 90 min. The primary end-point was all-cause mortality at 30 days and the hypothesis was that the two treatments would be equivalent. By 30 days, 6.61% of alteplase-treated patients and 6.75% lanoteplase-treated patients had died (relative risk 1.02). Total stroke occurred in 1.53% alteplase- and 1.87% lanoteplase-treated patients (ns); haemorrhagic stroke rates were 0.64% alteplase and 1.12% lanoteplase (P=0.004). The net clinical deficit of 30-day death or non-fatal disabling stroke was 7.0% and 7.2%, respectively. By 6 months, 8.8% of alteplase-treated patients and 8.7% of lanoteplase-treated patients had died. CONCLUSION Single-bolus weight-adjusted lanoteplase is an effective thrombolytic agent, equivalent to alteplase in terms of its impact on survival and with a comparable risk-benefit profile. The single-bolus regimen should shorten symptoms to treatment times and be especially convenient for emergency department or out-of-hospital administration.

Published
2000

4. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial

Author

Lechat, P, Brunhuber, Kw, Hofmann, R, Kuhn, P, Nesser, Hj, Slany, J, Weihs, W, Wiedermann, C, Wimmer, H, van Mieghem, W, Boland, J, Chaudron, Jm, Jordaens, L, Melchior, Jp, Aschermann, M, Bruthansl, J, Hradec, M, Kolbel, F, Semrad, B, Haghfelt, T, Fischer Hansen, J, Goetzsche, Co, Hildebrandt, P, Kassis, E, Rasmussen, V, Rokkedal, J, Thomassen, A, Groundstroem, K, Uusimaa, P, Le Heuzey JY, Aumont, Mc, Aupetit, Jf, Baille, N, Baudouy, P, Belin, A, Bonneau, A, Bonneric, G, Bousser, Jp, Citron, B, Dary, P, Decoulx, E, De Groote, P, Denolle, T, Dievart, F, Duriez, P, Eicher, Jc, Enjuto, G, Ferriere, M, Fournier, E, Garandeau, M, Gauthier, J, Genest, M, Gerbe, A, Godenir, Jp, Guillot, B, Guillot, Jp, Guillot, P, Heno, P, D'Ivernois, C, Jean, M, Kacet, S, Kalle, R, Komajda, M, Lacroix, A, Lallemand, R, Lardoux, H, Marquet, M, Martin, M, Martin, O, Mery, D, Mossaz, R, Mothes, P, Olive, T, Ostorero, M, Paganelli, F, Page, E, Pauly Laubry, C, Puel, J, Rousseau, Jf, Roux, Jj, Schenowitz, A, Sourdais, K, Tremel, F, Verdun, A, Witchiz, S, Wolf, Je, Hombach, V, Assmann, I, Beyer, T, Bischoff, Ko, Darius, H, Ertl, G, Fleck, E, Forster, K, Freytag, F, Gleichmann, U, Haasis, R, Henssge, R, Hey, D, Hesse, P, Hofs, T, Keck, M, Klein, H, Kromer, Et, Kruls Munch, J, Luderitz, B, Maisch, B, Mitrovic, V, Neubauer, S, Osterziel, Kj, Simon, H, Spitzer, Sg, Stohring, R, Taubert, G, Teichmann, W, Theisen, K, Wende, W, Wieser, H, Zotz, R, Preda, I, Csanady, M, Cserhalmi, L, Edes, I, Gesztesi, T, Karpati, P, Simon, K, Tarjan, J, Fogari, R, Tramarin, R, Galie, N, Giani, P, Milanese, U, Scalvini, S, Scrutinio, D, Sechi, Leonardo Alberto, Tettamanti, F, De Vito, F, Crean, P, Mccann, H, Mulcahy, D, Sugrue, D, van Hoogenhuyze DCA, van der Burgh PH, Ciampricotti, R, van Dantzig JM, Denhartog, Fr, Henneman, Ja, van Kesteren HAM, Kragten, Ja, Liem, Kl, Limburg, A, van der Linde MR, Linssen, Gcm, Pasteuning, H, Penn, Hjam, Van Rossum, P, Schaafsma, Hj, Schelling, A, Sloos, R, Wesdorp, Jcl, Korewicki, J, Achremczyk, P, Czestockowska, E, Dowgird, M, Dyduszynski, A, Gorski, J, Ilmurzynska, K, Janicki, K, Kornacewicz Jach, Z, Kraska, T, Krzeminska Pakula, M, Kuch, J, Nartowicz, E, Petelenz, T, Piwowarska, W, Rawczynska Englert, I, Ruzyllo, W, Swiatecka, G, Tendera, M, Wierzchowiecki, M, Wodniecki, J, Wojciechowoski, D, Wrabec, K, Wysocki, H, Gomes, Rs, Ceia, Mf, Lousada, N, Campos, Jmm, Providencia, La, de Moura ALZC, Marejev, Vj, Aronov, Dm, Arutjunov, Gp, Bart, Bj, Basechikin, Ss, Belenkov, Jn, Beloussov, Jb, Bokeria, Oa, Charchogljan, Ra, Doschytsin, V, Fedorova, Ta, Glezer, Mg, Gorbachenkov, A, Gorshkov, Va, Gospodarenko, Al, Ivashkin, Vt, Ivleva, Aj, Kyrichenko, Aa, Lavrov, Aa, Lazebnik, Lb, Marynov, A, Mazaev, Vp, Polejev, Nr, Shpektor, A, Sidorenko, Ba, Sobolev, Ke, Starodoubtsev, Ak, Storozhakhov, Gi, Syrkin, Al, Zodionchenko, Vs, Zvereva, Tv, Murin, J, Kaliska, G, Rybar, R, Valle, V, Artaza, M, Conthe, P, Cruz, Jm, Garcia Moll, M, Lopez Sendon JL, Martinez, A, Monzon, F, Ribas, M, Roig, E, Roldan, I, Hoglund, C, Ekdahl, S, Hjelmaeus, L, Lindberg, K, Lofdahl, P, Ulvenstam, G, Warselius, L, Follath, F, Anghern, W, Dubach, P, Erne, P, Gallino, A, Moccetti, T, Bridges, A, Adgey, J, Ambepitiya, G, Boon, N, Boyle, Rm, Cowley, Aj, Cripps, T, Davies, Mk, Dunn, F, Findlay, J, Forsey, P, Fyfe, T, Gould, B, Greenwood, Tw, Hubner, P, Khan, S, Lewis, P, Mackay, A, Maltz, M, Mcarthur, J, Mcleod, A, Mcleod, D, Metcalfe, M, Millar Craig, M, Mills, P, Nelson, Jk, Nicholls, D, Oakley, Gd, Patterson, Dlh, Pohl, Jef, Ray, S, Silke, B, Wilkinson, Pr, and Jmouro, Av

Published
1999

5. Prognostic factors in medically treated patients with chronic pulmonary embolism.

Author

Lewczuk J, Piszko P, Jagas J, Porada A, Wójciak S, Sobkowicz B, Wrabec K, Lewczuk, J, Piszko, P, Jagas, J, Porada, A, Wójciak, S, Sobkowicz, B, and Wrabec, K

Abstract

Objective: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy.Study Design: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months).Results: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean +/- SD) level of PaO(2) (59.3 +/- 11 mm Hg) than the nonsurvivors (50.8 +/- 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30.3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 +/- 6 vs 44.2 +/- 6; p = 0.03), and better exercise tolerance (4.8 +/- 3 multiples of resting O(2) consumption [METs] vs 2.5 +/- 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04).Conclusion: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance. [ABSTRACT FROM AUTHOR]

Published
2001
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12. Experience from controlled trials of physical training in chronic heart failure - Protocol and patient factors in effectiveness in the improvement in exercise tolerance

Author

Maugeri, F. S., Campana, M., Ferrari, R., Giordano, A., Scalvini, S., Volterrani, M., Bernardi, L., Calciati, A., Finardi, G., Perlini, S., Radaelli, A., Solda, P. L., Adamopoulos, S., Coats, A. J. S., Chua, T. P., Piepoli, M., Poole-Wilson, P. A., Piotr Ponikowski, Webb-Peploe, K., Barlow, C., Conway, J., Davey, P. P., Meyer, T. E., Paterson, D. J., Robbins, P., Sleight, P., Kara, T., Souce, M., Spinarova, L., Stejfa, M., Toman, J., Zatloukal, B., Szelemery, R., Wrabec, K., and European Heart Failure Training, Grp

15. The IMPROVEMENT study (IMprovement PROgram in eValuation and managEMENT of heart failure) - Rationale and design | Załozenia programu IMPROVEMENT (IMprovement PROgram in eValuation and managEMENT of heart failure)

Author

Korewicki, J., Tendera, M., Browarek, A., Zieliński, T., Cleland, J. G. F., Cohen Solal, A., Cosin Aguilar, J., Dietz, R., Eastaugh, J., Follath, F., Nick Freemantle, Gavazzi, A., Gilst, W. H., Hobbs, F. D. R., Madeira, H. C., Preda, I., Swedberg, K., Widimski, J., Cieśliński, A., Dabrowski, M., Kornacewicz-Jach, Z., Krzemińska-Pakuła, M., Opolski, G., Poloński, L., Rynkiewicz, A., Wrabec, K., and Wysocki, H.

18. Effect of metoprolol CR XL in chronic heart failure: Metoprolol CR XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)

Author

Hjalmarson, A., Goldstein, S., Fagerberg, B., Wedel, H., Waagstein, F., Kjekshus, J., Wikstrand, J., Westergren, G., Hassle, A., Thimell, M., El Allaf, D., Vitovec, J., Aldershvile, J., Halinen, M., Dietz, R., Neuhaus, Kl, Janosi, A., Thorgeirsson, G., Dunselman, P., Gullestad, L., Kuch, J., Herlitz, J., Rickenbacher, P., Ball, S., Gottlieb, S., Deedwania, P., Vandenhoven, G., Novakova, I., Danker, S., Lundstrom, M., Meyer-Sabellek, W., Balla, I., Sveinsdottir, M., Dorhout, B., Hildebrandt, A., Szczurko, I., Larsson, C., Bucher, E., Scott, E., Dwyer, D., Julian, Dg, Demets, Dl, Chatterjee, K., Feyzi, J., Lehto, S., Karpati, P., Motz, W., Samuelsson, O., Viersma, Jw, Andersson, B., Berthe, C., Boutefeu, Jm, Boxho, G., Decroly, P., Derbaudrenghien, Jp, Pirlet, J., Henry, P., Heyndrickx, G., Missault, L., Nannan, M., Timmermans, P., Vachiery, Jl, Mieghem, W., Vandenbossche, Jl, Dvorak, K., Herold, M., Hradec, J., Kana, A., Petr, P., Rybka, J., Smid, J., Svitil, P., Toman, J., Agner, E., Amtorp, O., Egstrup, K., Eliasen, P., Gotzsche, Co, Hildebrandt, P., Johannesen, A., Kaiser-Nielsen, P., Nielsen, H., Nielsen, Pe, Pedersen, F., Nielsen, Jr, Skagen, K., Honkanen, T., Hussi, E., Juvonen, J., Jaaskelainen, H., Rinne, J., Salonen, T., Andresen, D., Berwing, H., Forster, A., Hauf, Gf, Krosse, B., Luderitz, B., Olshausen, Ke, Schmailzl, Kjg, Schwimmbeck, Pl, Sigmund, M., Voller, H., Czuriga, I., Hetey, M., Katona, A., Lengyel, M., Nyaradi, A., Rednik, A., Sandori, K., Szabo, P., Tarjan, J., Tenczer, J., Timar, S., Valyi, P., Veress, G., Zamolyi, K., Oze, B., Bernink, Pjlm, Bredero, Ac, Breedveld, Rw, Breuls, Pnwm, Bucx, Jjj, jan cornel, Milliano, Par, Dunselman, Phjm, Hamer, Bjb, Holwerda, Nl, Hoogsteen, J., Hoorntje, Jca, Kragten, Ja, Liem, Ah, Linssen, Gcm, Michels, Hr, Misier, Arr, Schaafsma, Hj, Sijbring, P., Taverne, Rjt, Kempen, Lhj, Stralen, R., Veldhuisen, Dj, Veerhoek, Mj, Werter, Cjpj, Wesdorp, Jcl, Willems, Ar, Withagen, Ajam, Zwart, Pag, Bjornerheim, R., Dahle, M., Dickstein, K., Froland, Gs, Gundersen, T., Hofsoy, K., Hole, Tl, Johansen, T., Mannsverk, J., Nesje, P., Omland, Tm, Sjodin, C., Smith, P., Tjonndal, Ha, Vikesdal, O., Waage, K., Jaworska, K., Kolodziej, P., Kornacewicz-Jach, Z., Krzeminska-Pakula, M., Piotrowski, Jw, Piwowarska, W., Stogowski, A., Wodniecki, J., Wrabec, K., Ahlstrom, P., Ekdahl, S., Hemmingson, Lo, Holmberg, L., Lernfelt, B., Nilsson, H., Widgren, B., Angman, K., Erne, P., Mohacsi, P., Polikar, R., Schlapfer, H., Batin, P., Berkin, Ke, Callaghan, Ts, Forfar, J., Frenneaux, M., Greenbaum, Ra, Maltz, M., Murdoch, D., Reynolds, G., Stephens, J., Struthers, A., Swan, J., Tildesley, G., Abbasi, A., Alagona, P., Alderman, J., Alipour, M., Anderson, Jl, Ansari, Z., Ashraf, M., Beanblossom, Bt, Bennett, S., Benvenuti, D., Berk, MR, Bhalla, R., Bilazarian, Sd, Browne, Kf, Buchter, Cm, Carlson, R., Carlson, Cj, Danisa, K., Dauber, I., Dewood, Ma, Dennish, G., Denny, Dm, Dibianco, R., Diller, Pm, Dunlap, M., Dowd, K., Edmiston, A., El Shahawy, M., Elkayam, U., Farnham, J., Fenster, P., Friedman, S., Heywood, T., Galichia, Jp, Geller, M., Ghali, Jk, Gheorghiade, M., Giles, T., Gillespe, R., Goldberg, G., Goldberg, Mc, Goldscher, Da, Gooden, Gp, Goodman, M., Goodman, L., Gorwit, J., Gottlieb, Ss, Gradman, A., Grech, D., Hack, T., Hall, Jh, Hattenhauer, Mt, Higginbotham, Mb, Hutchins, S., Imburgia, M., Iteld, Bj, Jackson, B., Jafri, S., Jauch, W., Jennison, S., Kahn, Bh, Kao, W., Kaplan, K., Karlsberg, R., Kennedy, Hl, Kennedy, Jj, Kirkegaard, L., Kraus, Dh, Labresh, K., Lalonde, L., Lesser, Mf, Levites, R., Levy, M., Lewis, Rk, Loh, Ik, Madyoon, H., Maislos, F., Mann, D., Maurice, Gl, Nisar, A., Old, W., Pappas, Jd, Phadke, K., Promisloff, S., Rashkow, Am, Reeves, B., Rosen, Jh, Rotman, M., Saleem, T., Savran, Sv, Shah, R., Shalev, Y., Shanes, Jg, O Shaughnessy, M., Silverman, B., Steingart, Rm, Swenson, L., Syed, K., Thadani, U., Thorsen, Rd, Tonkon, Mj, Touchon, R., Uhl, G., Vaska, Kj, Wagner, Sg, Weaver, Cj, Weiss, Rj, Wickemeyer, Wj, Willens, Hj, Wilson, Jr, Wright, R., and Yellen, L.

23. Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive heart failure.

Author

Ponikowski, Piotr, Tuan Peng Chua, Piepoli, Massimo, Banasiak, Waldemar, Anker, Stefan D., Szelemej, Roman, Molenda, Wlodzimierz, Wrabec, Krzysztof, Capucci, Alessandro, Coats, Andrew J.S., Ponikowski, P, Chua, T P, Piepoli, M, Banasiak, W, Anker, S D, Szelemej, R, Molenda, W, Wrabec, K, Capucci, A, and Coats, A J

Subjects
*VENTILATION-perfusion ratio, *CONGESTIVE heart failure, *HEART beat, *EXERCISE physiology
Abstract

In chronic congestive heart failure (CHF) an overactivity of muscle ergoreceptors and peripheral chemoreceptors may lead to an increased ventilatory response to exercise and contribute to the autonomic imbalance. The analysis of heart rate variability (HRV), which is a reliable method of studying autonomic regulations within the cardiovascular system, showed depressed HRV indexes in CHF, but predictors of abnormal HRV pattern in CHF remain controversial. Considering a common mechanism involved in generation of both abnormal ventilation and autonomic dysfunction in CHF, we hypothesized that impaired ventilation may be better than other variables of CHF severity in determining HRV parameters. Seventy-two patients with CHF (57+/-9 years, ejection fraction: 28+/-11%) underwent cardiopulmonary exercise testing; the relation between ventilation and carbon dioxide production (VE/VCO2) was used as an index of the ventilatory response to exercise. Time and frequency-domain measurements of HRV were derived from 24-hour electrocardiographic monitoring. Patients had reduced exercise tolerance with abnormal ventilatory response (peak oxygen consumption [VO2max]: 17.8+/-5.5 ml/kg/min, VE/VCO2: 36.0+/-9.8). Correlations were found between HRV measures and etiology, New York Heart Association (NYHA) functional class, and VO2max, but the strongest relation was observed for VE/VCO2 slope (r values from -0.33 to -0.65, p <0.01). In the multiple regression analysis only VE/VCO2 was found to correlate independently with all HRV measurements. To investigate the role of peripheral chemoreceptor overactivity as the mechanism of autonomic imbalance and the increased ventilatory response to exercise, we assessed peripheral chemosensitivity in 22 patients (mean value of peripheral chemosensitivity: 0.62+/-0.34 L/min/%SaO2, significantly higher than in normal controls, mean value: 0.29+/-0.20 L/min/%SaO2 in our laboratory). The activity of the peripheral chemoreflex inversely correlated with all parameters of HRV. Increased ventilatory response to exercise correlated with depressed HRV measures in patients with CHF better than other clinical variables. An important role of the increased peripheral chemosensitivity in this relation may be relevant, being also a potential link between functional severity and sympathovagal imbalance in CHF. [ABSTRACT FROM AUTHOR]

Published
1998
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24. The natural history of thromboembolic pulmonary hypertension. Since when is it chronic? A proposal of an algorithm for the diagnosis and treatment.

Author

Lewczuk J, Romaszkiewicz R, Lenartowska L, Piszko P, Jagas J, Nowak M, Mroczek E, Błaszczyk D, Witkiewicz W, and Wrabec K

Subjects
Disease Progression, Humans, Hypertension, Pulmonary etiology, Algorithms, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary therapy, Thromboembolism complications
Published
2013
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25. How often pulmonary embolism mimics acute coronary syndrome?

Author

Kukla P, Długopolski R, Krupa E, Furtak R, Mirek-Bryniarska E, Szełemej R, Jastrzębski M, Nowak J, Kulak L, Hybel J, Wrabec K, Kawecka-Jaszcz K, and Bryniarski L

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Chest Pain etiology, Diagnosis, Differential, Electrocardiography, Humans, Male, Middle Aged, Retrospective Studies, Troponin T blood, Acute Coronary Syndrome diagnosis, Pulmonary Embolism diagnosis
Abstract

Background: The clinical picture of acute pulmonary embolism (APE) is often uncharacteristic and may mimic acute coronary syndrome (ACS) or lung diseases, leading to misdiagnosis. In 50% of patients, APE is accompanied by chest pain and in 30-50% of the patients markers of myocardial injury are elevated., Aim: To perform a retrospective assessment of how often clinical manifestations and investigations (ECG findings and elevated markers of myocardial injury) in patients with APE may be suggestive of ACS., Methods: We included 292 consecutive patients (109 men and 183 women) from 17 to 89 years of age (mean age 65.4 ± 15.5 years) with APE diagnosed according the ESC guidelines., Results: Among the 292 patients included in the study 33 patients died during hospitalisation (mortality rate 11.3%) and 73 (25.0%) patients developed complications. A total of 75 (25.7%) patients were classified as high risk according to the ESC risk stratification, 163 (55.8%) as intermediate risk and 54 (18.5%) as low risk. Chest pain on and/or before admission was reported by 128 (43.8%) patients, including 73 (57.0%) patients with chest pain of coronary origin, 52 (40.6%) patients with chest pain of pleural origin and 3 patients with pain of undeterminable origin based on the available documentation. A total of 56 (19.2%) patients had a history of ischaemic heart disease and 5 (1.7%) had a history of myocardial infarction. A total of 8 (2.7%) patients were admitted with the initial diagnosis of ACS. The high-risk group consisted of 15 (20.6%) patients with a typical retrosternal chest pain and 60 (27.3%) patients without the typical anginal pain. Elevated troponin was observed in 103 (35.3%) patients. The ECG changes suggestive of myocardial ischaemia (inverted T waves, ST-segment depression or elevation) were observed in 208 (71.2%) patients. The following findings were significantly more common in high-risk versus non-high-risk patients: ST-segment depression in V4-V6 (42.6% vs 23.9%, p = 0.02), ST-segment elevation in V1 (46.7% vs 20.0%, p = 0.0002) and aVR (70.7% vs 40.1%, p = 0.0007)., Conclusions: One third of patients with APE may present with all the manifestations (pain, elevated troponin and ECG changes) suggestive of ACS. The ECG changes suggestive of myocardial ischaemia are observed in 70% of the patients with ST-segment depression in V4-V6 and ST-segment elevation in V1 and aVR being significantly more common in high-risk vs non-high-risk patients.

Published
2011

26. The value of ECG parameters in estimating myocardial injury and establishing prognosis in patients with acute pulmonary embolism.

Author

Kukla P, Długopolski R, Krupa E, Furtak R, Wrabec K, Szełemej R, Mirek-Bryniarska E, Wańczura P, Jastrzębski M, and Bryniarski L

Subjects
Acute Disease, Aged, Aged, 80 and over, Biomarkers metabolism, Electrocardiography standards, Female, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Predictive Value of Tests, Prognosis, Pulmonary Embolism mortality, Pulmonary Embolism physiopathology, Regression Analysis, Electrocardiography methods, Myocardial Infarction complications, Pulmonary Embolism complications, Troponin metabolism
Abstract

Background: The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE)., Aim: To assess the significance of ECG changes in predicting myocardial injury and prognosis in patients with APE., Methods: The study group consisted of 225 patients (137 women and 88 men), mean age: 66.0 ± 15.2 years, in whom the diagnosis of APE was made, mostly based on computed tomography (n = 206, 92%)., Results: We observed 26 in-hospital deaths (mortality rate: 11.5%) and complications occurred in 58 (25.7%) patients. Elevated levels of troponin were observed in 103 (46%) patients. Logistic regression analysis showed that in-hospital mortality was associated with: coronary chest pain (0.06-0.53, OR 0.18), systolic blood pressure below 100 mm Hg (2.3-13.64, OR 5.61), heart rate above 100 bpm (1.17-15.11, OR 4.21), the S1Q3T3 sign (1.31-6.99, OR 3.02), QR in V(1) (1.60-12.32, OR 4.45), ST-segment depression in V(4)-V(6) (0.99-5.40, OR 2.31), ST-segment elevation in III (0.99-6.96, OR 2.64), ST-segment elevation in V(1) (1.74-9.49, OR 4.07); borderline (1.51-16.07, OR 4.93), moderate (1.42-17.74, OR 5.01) and severe troponin elevation (2.88-36.38, OR 10.24). In patients with cTnT(+), compared to patients with normal troponin levels, the following ECG changes were significantly more common: the S1Q3T3 sign (43 vs 21%, p = 0.003), negative T waves in V(2)-V(4) (57 vs 27%, p = 0.0001), ST-segment depression in V(4)-V(6) (40 vs 14%, p = 0.001), ST-segment elevation in III (22 vs 7%, p = 0.0006), V(1) and V(2) (43 vs 10%, p = 0.0001) and QR in V(1) (16 vs 5%, p = 0.007)., Conclusions: ECG parameters are useful in predicting myocardial injury and assessing prognosis in patients with APE.

Published
2011

27. [Editorial].

Author

Wrabec K

Subjects
Humans, Cannabis adverse effects, Myocardial Infarction chemically induced, Stroke chemically induced
Published
2010

28. [Treprostinil therapy for distal chronic thromboembolic pulmonary hypertension].

Author

Szafran B, Lewczuk J, Mazij M, Piszko P, Lenartowska L, Sośnik K, and Wrabec K

Subjects
Aged, Chronic Disease, Epoprostenol therapeutic use, Female, Humans, Treatment Outcome, Antihypertensive Agents therapeutic use, Epoprostenol analogs & derivatives, Hypertension, Pulmonary drug therapy, Pulmonary Embolism drug therapy
Abstract

We present a case of a 77-year-old female with distal chronic thromboembolic pulmonary hypertension. Diagnostic and therapeutic difficulties are discussed. Clinical and haemodynamic benefits resulting from treprostinil therapy added to continuous anticoagulation are shown.

Published
2008

29. [Cardiac tamponade due to angiosarcoma--was surgical treatment necessary? A case report].

Author

Sośnik K, Lewczuk J, Ludwik B, Kowal J, Sobkowicz B, Gwoźdź W, and Wrabec K

Subjects
Antineoplastic Combined Chemotherapy Protocols therapeutic use, Echocardiography, Female, Hemangiosarcoma secondary, Hemangiosarcoma therapy, Humans, Mediastinal Neoplasms diagnosis, Mediastinal Neoplasms secondary, Middle Aged, Pericardial Effusion etiology, Pericardial Effusion therapy, Tomography, X-Ray Computed, Treatment Outcome, Vascular Neoplasms diagnosis, Vascular Neoplasms secondary, Cardiac Tamponade etiology, Cardiac Tamponade surgery, Heart Neoplasms complications, Heart Neoplasms diagnosis, Hemangiosarcoma complications, Hemangiosarcoma diagnosis
Abstract

We present a case of a 49-year-old patient with cardiac tamponade due to haemopericardium. The decision to perform surgery, although controversial, allowed to diagnose cardiac angiosarcoma with metastases to pericardium, vena cava superior and pulmonary trunk. Consequently, chemotherapy was instituted and was initially effective, however, the patient died 12 months later due to the progression of the disease.

Published
2006

30. Betaxolol is equivalent to carvedilol in patients with heart failure NYHA II or III: result of a randomized multicenter trial (BETACAR Trial).

Author

Figulla HR, Krzeminska-Pakula M, Wrabec K, Chochola J, Kalmbach C, and Fridl P

Subjects
Adolescent, Adrenergic beta-Antagonists administration & dosage, Adult, Aged, Betaxolol administration & dosage, Carbazoles administration & dosage, Carvedilol, Double-Blind Method, Echocardiography, Female, Follow-Up Studies, Heart Failure diagnostic imaging, Heart Failure physiopathology, Humans, Male, Middle Aged, Propanolamines administration & dosage, Retrospective Studies, Stroke Volume drug effects, Stroke Volume physiology, Treatment Outcome, Adrenergic beta-Antagonists therapeutic use, Betaxolol therapeutic use, Carbazoles therapeutic use, Heart Failure drug therapy, Propanolamines therapeutic use
Abstract

Background: In a recent COMET trial (Lancet 362, 2003:7-13) it could be demonstrated that carvedilol < or = 50 mg/d was superior to metoprolol tartrate < or = 100 mg/d in the treatment of heart failure patients NYHA II-IV., Objectives: It was investigated whether the superiority of carvedilol with its beta1, beta2 and alpha-blocking potency will persist in a comparison to a highly selective beta1-blocker with a long plasma half-time such as betaxolol., Methods: 255 pts. with NYHA II or III heart failure were double-blind randomized and uptitrated to either carvedilol 25 mg bid (n=131) or betaxolol 20 mg od (n=124)., Results: Within 8 months left ventricular ejection fraction (LVEF) increased to the same extent from 30% to 43% (carvedilol) or 31% to 43% (betaxolol) as primary endpoint (ns). 13% of the carvedilol (CAR) patients versus 15% of the betaxolol patients (BET) suffered either from cardiac death or recurrent hospitalizations (cardiac death n=6 (CAR), n=2 (BET), ns). The mean increase in the 6-min walk test was 63 m with CAR and 61 m with BET and the Minnesota living with heart failure questionnaire improved in both groups (ns). Heart rate reduction was pronounced in both groups: CAR 13.1 beats/min, BET 13.6 beats/min., Conclusions: The long acting highly selective beta1-blocker betaxolol in an adequate dosage is not inferior to carvedilol in terms of exercise tolerance, safety and effects on left ventricular function.

Published
2006
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31. Results of one-year anticoagulation in patients with newly detected chronic thromboembolic pulmonary hypertension not treated with pulmonary endarterectomy.

Author

Romaszkiewicz R, Lewczuk J, Piszko P, Jagas J, Lenartowska L, Ludwik B, Sawa W, and Wrabec K

Subjects
Adult, Aged, Aged, 80 and over, Chronic Disease, Female, Follow-Up Studies, Humans, Hypertension, Pulmonary etiology, Longitudinal Studies, Male, Middle Aged, Prognosis, Pulmonary Embolism complications, Time Factors, Treatment Outcome, Acenocoumarol therapeutic use, Anticoagulants therapeutic use, Endarterectomy, Hypertension, Pulmonary prevention & control, Pulmonary Embolism drug therapy, Pulmonary Embolism surgery
Abstract

Introduction: Currently pulmonary endarterectomy is considered the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is not known if this option should be recommended in all suitable patients as it is highly variable with respect to prognosis. There is also doubt about selection of adequate time to refer patients with CTEPH for surgery., Aim: To establish whether some patients with CTEPH may clinically benefit from isolated anticoagulation with drugs and if the use of anticoagulation may have any impact on the time of patient referral for pulmonary endarterectomy., Methods: The prospective analysis involved 29 patients (9 male, 20 female) aged 37 to 82 years, with pulmonary arterial systolic pressure ranging from 39 to 133 mmHg and newly diagnosed CTEPH who had not been treated with pulmonary endarterectomy and were not receiving anticoagulation. Survival, functional status according to NYHA classification, duration of thromboembolism, exercise tolerance and echocardiographic parameters of right ventricular overload before and at one year after initiation of therapy with anticoagulants were evaluated., Results: During follow-up, 3 patients with PASP ranging from 120 to 133 mmHg died. In 26 patients with PASP 39-115 mmHg, who survived, improvement in echocardiographic parameters of right ventricular overload, better exercise tolerance as well as functional status according to NYHA classification was observed. In 12 survivors, pulmonary pressure returned to normal., Conclusions: The results of this study suggest that favourable effects of isolated anticoagulation are likely in patients with newly detected CTEPH, mild and moderate baseline pulmonary hypertension and acceptable exercise tolerance. They also indicate the necessity of anticoagulation in these patients prior to possible referral for pulmonary endarterectomy.

Published
2006

32. [One-year controlled therapy with doxazosin in patients with pulmonary hypertension due to chronic obstructive pulmonary disease].

Author

Ludwik B, Lewczuk J, Piszko P, Nowak M, and Wrabec K

Subjects
Adult, Aged, Aged, 80 and over, Drug Administration Schedule, Echocardiography, Exercise Test, Female, Humans, Hypertension, Pulmonary etiology, Hypertension, Pulmonary physiopathology, Lung blood supply, Male, Middle Aged, Adrenergic alpha-Antagonists administration & dosage, Doxazosin administration & dosage, Hypertension, Pulmonary drug therapy, Pulmonary Disease, Chronic Obstructive complications
Abstract

Unlabelled: It was shown recently that a thirty day doxazosin therapy, that was undertaken to prove alpha1-adrenergic hypothesis for pulmonary hypertension, resulted in a significant improvement of pulmonary hemodynamics in patients with hypoxic pulmonary hypertension (HPH) due to COPD., Aim of the Study: The objective of this study was to learn if 12 months long therapy with 2 mg of doxazosin daily (dosage effective in recent research) may result in persistent hemodynamical and clinical benefits., Material and Methods: To this end, baseline and after 1 year results of echocardiography, symptom-limited maximal exercise test, and arterial blood gaseous analysis were evaluated at baseline and after 12-month study in 32 patients with HPH randomized either to doxazosin treated group (16 patients, aged 60.2 +/- 12 years, or to control group (16 patients, aging 60.5 +/- 4 years). At baseline doxazosin treated COPD patients had less advanced disease than COPD control patients (FVC 2.4 +/- 0.7 vs 1.3 +/- 0.31, p<0,001 and FEV1 1.6 +/- 0.6 vs 0.7 +/- 0.31, p<0,001)., Results: This study showed that results of tricuspid gradient, acceleration time, right ventricular enddiastolic diameter, left ventricular enddiastolic diameter and left ventricular ejection fraction did not differ significantly in both groups between baseline and 1-year assessment. The number of METs achieved during exercise test and results of PaO2 and PaCO2 did not change significantly in both groups either., Conclusion: The study indicates lack of hemodynamical and clinical improvement during a 1-year doxazosin therapy in patients with HPH due to COPD.

Published
2006

33. [Normal coronary angiogram in patient with diagnosis of acute coronary syndrome with ST segment elevation. Was it possible to recognise acute pulmonary embolism earlier?].

Author

Ludwik B, Lewczuk J, Piszko P, Wysoczański T, Kowal J, Sośnik K, and Wrabec K

Subjects
Acute Disease, Diagnosis, Differential, Early Diagnosis, Electrocardiography, Humans, Male, Middle Aged, Atrioventricular Node physiopathology, Coronary Angiography methods, Coronary Disease diagnosis, Coronary Disease physiopathology, Pulmonary Embolism diagnosis
Abstract

A case of a 48 year old male scheduled for early invasive treatment of acute coronary syndrome with ST segment elevation is presented. Clinical suspicion of acute pulmonary embolism was undertaken because of normal coronary angiogram and was confirmed by pulmonary angiography. Differential diagnosis based on medical history, electrocardiogram and laboratory findings was discussed.

Published
2006

34. [Characteristics of acute, hemodynamically stable pulmonary embolism presenting as a syncope].

Author

Błaszczyk D, Lewczuk J, Piszko P, Ludwik B, Konieczny A, Nowak M, Stopyra-Poczatek M, and Wrabec K

Subjects
Acute Disease, Aged, Aged, 80 and over, Anticoagulants therapeutic use, Female, Humans, Male, Middle Aged, Pulmonary Artery diagnostic imaging, Pulmonary Embolism complications, Radiography, Ultrasonography, Pulmonary Embolism diagnosis, Syncope etiology
Abstract

Syncope (S) occurs in approximately 10% patients with acute pulmonary embolism (APE) and is commonly ascribed to the massive, hemodynamically instable APE. The aim of the study was to assess the occurrence and significance of S revealing hemodynamically stable APE. We found syncope in 6 of 21 (29%) consecutive patients (16 females, 5 males; age from 46-87 years, mean age of 71 years) who were diagnosed with APE and in whom other reasons for S were excluded. All patients were treated with anticoagulation. They all survived hospitalization and no APE recurrences were found during in-hospital period. Patients with APE-S compared to patients with APE and without S had smaller baseline RVED (21.2 +/- 2 vs. 27.3 +/- 5.6, p = 0.01), however both groups did not differ statistically in baseline vital signs, angiographic, hemodynamic, other echocardiographic parameters as well as in the results of laboratory findings. It is concluded, that S signals hemodynamically stable APE more frequently than is quoted. APE-S patients could not be clearly discriminate from APE patients without S on the basis of the parameters studied and S did not impact the course of APE during in- hospital period.

Published
2006

35. [Bronchial adenocarcinoma mimicking acute pulmonary embolism -- a case report].

Author

Bugajna K, Lewczuk J, Piszko P, Lenartowska L, Nowak M, Ludwig B, Prajs P, and Wrabec K

Subjects
Adult, Autopsy, Diagnosis, Differential, Fatal Outcome, Humans, Male, Adenocarcinoma pathology, Bronchial Neoplasms pathology, Pulmonary Embolism pathology
Abstract

A case of a 31-year-old male with medical history, clinical symptoms and additional diagnostic tests strongly suggesting diagnosis of acute pulmonary embolism is presented. However, pulmonary emboli were not seen during pulmonary angiography. At autopsy bronchial carcinoma was found and this definitive diagnosis was confirmed by the results of histopathological study.

Published
2005

36. [Impact of 30 day therapy with doxazosin--alpha1 adrenergic blocker on pulmonary hemodynamics in patients with secondary pulmonary hypertension due to chronic obstructive pulmonary disease].

Author

Lewczuk J, Piszko P, Jagas J, and Wrabec K

Subjects
Adrenergic alpha-Antagonists administration & dosage, Aged, Doxazosin administration & dosage, Female, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Adrenergic alpha-Antagonists pharmacology, Doxazosin pharmacology, Hypertension, Pulmonary drug therapy, Pulmonary Circulation drug effects, Pulmonary Disease, Chronic Obstructive drug therapy
Abstract

To prove alpha1-adrenergic hypothesis for pulmonary hypertension we studied 6 patients aged 63.3 +/- 8 (range 50-75) years with stable, advanced chronic obstructive pulmonary disease (COPD), FEV=1.51 +/- 0.3 I and with pulmonary hypertension, mean pulmonary artery pressure 28.3 +/- 8 (range 21-40) mm Hg. a1 blocker, doxazosin was administered per os in a daily dose of 2-3 mg. Pulmonary hemodynamics was performed before and after 30 day of treatment. After therapy, compared to baseline results, pulmonary artery systolic pressure decreased from 48.6 +/- 14 to 42.5 +/- 13 mm Hg, p=0.003, pulmonary artery diastolic pressure from 14.5 +/- 6 to 7 +/- 4 mm Hg, p=0.02), mean pulmonary artery pressure from 28.3 +/- 8 to 21.1 +/- 5 mm Hg, p=0.01 and pulmonary vascular resistance from 389.6 +/- 14 to 234.6 +/- 73 dyn x s x cm5. No significant changes in pulmonary artery wedge pressure, cardiac output, arterial oxygen content, percent saturation of hemoglobin with oxygen and oxygen delivery were found. In summary, the results of 30 day doxazosin therapy support alpha1 adrenergic hypothesis for pulmonary hypertension and suggest potential clinical benefits during long term treatment in patients with pulmonary hypertension due to COPD.

Published
2005

37. Trends in the incidence of the free wall cardiac rupture in acute myocardial infarction. observational study: experience of a single center.

Author

Sobkowicz B, Lenartowska L, Nowak M, Hirnle T, Borys D, Kosicki M, Prajs P, and Wrabec K

Subjects
Acute Disease, Age Distribution, Aged, Female, Heart Rupture, Post-Infarction diagnosis, Humans, Incidence, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Poland epidemiology, Prognosis, Sex Distribution, Thrombolytic Therapy, Heart Rupture, Post-Infarction epidemiology, Myocardial Infarction epidemiology
Abstract

Purpose: Free wall cardiac rupture (CR) is one of the most common cause of in-hospital death in acute myocardial infarction (AMI). The early diagnosis of CR and selection of the patients predisposed to CR become an important clinical tool., Aim: assessing the occurrence of CR in patients with AMI, to determine the factors which could help to identify the patients threatened with CR., Material and Methods: 2320 consecutive patients with AMI. CR was proved by autopsy or by echocardiography performed during cardio-pulmonary resuscitation (CPR)., Results: In-hospital mortality was 11% (254 patients). 50 patients (2%) died from CR. CR was the cause of 20% of total in-hospital death. Patients with CR were older than survivors (72 vs 60 years, p<0.0001). Women prevailed in CR group: (62% in CR group vs 27% in the survivors, p<0.01). 29% of patients were treated with thrombolytics (Th+). Out of 58 patients from Th (+) group who died, 17 (29.31%) died because of CR. CR occurred in 33 (16.8%) patients out of 196 died in Th (-) group. In the logistic regression analysis only age and sex remained as predictors of CR. 16 patients died from CR during first 24 h from admission (ECR). In 34 patients CR occurred >24 h (LCR). In ECR group were no prevalence of women, while in LCR women constituted 68%. In ECR group all but one patient had no previous history of MI (p=0.06). Frequency of thrombolythic therapy was equal., Conclusions: Advanced age patients, particularly women with first AMI are at risk of CR. Decision of thrombolytic treatment in this group of patients must be very cautious.

Published
2005

38. Electrocardiographic signs of right ventricular overload in patients who underwent pulmonary embolism event(s). Are they useful in diagnosis of chronic thromboembolic pulmonary hypertension?

Author

Lewczuk J, Ajlan AW, Piszko P, Jagas J, Mikulewicz M, and Wrabec K

Subjects
Aged, Chronic Disease, Female, Humans, Male, Predictive Value of Tests, Pulmonary Artery diagnostic imaging, Radiography, Retrospective Studies, Sensitivity and Specificity, Electrocardiography, Hypertension, Pulmonary diagnosis, Pulmonary Embolism complications, Ventricular Dysfunction, Right diagnosis
Abstract

Diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) remains a major clinical problem. An attempt was made to learn whether electrocardiography has the potential to alleviate that problem. Sensitivity, specificity, negative and positive predictive value as well as a likelihood ratio of electrocardiogram (ECG) signs of right ventricular overload (RVO) were determined in 56 patients with chronic pulmonary embolism and a mean pulmonary artery pressure (mPAP) ranging from 15 to 80 mm Hg. CPE was recognized as the only disease in 44 patients (Group A) whereas the remaining 12 CPE patients suffered from concomitant cardiac and pulmonary diseases (Group B). Thirty three (59%) of the patients were diagnosed with CTEPH (mPAP exceeding 30 mm Hg). Twelve ECG signs of RVO were identified in the entire population of patients. At least a single ECG sign of RVO was found in 72% of the patients and 7 ECG signs were found exclusively in CTEPH patients. Negative T wave in precordial V1-V5 leads, negative T wave in II, III, aVF, pulmonary P wave and right axis deviation >90% occurred with the highest incidence that was determined to be 43%, 32%, 30%, and 30% respectively. These ECG signs of RVO had positive predictive value of those signs ranged from 80 to 100% in Group A and 25 to 75% in Group B, whereas their negative predictive value ranged from 44 to 76% and from 66.5 to 87.5% respectively. It is concluded that ECG signs of RVO appear to have the potential to aid in diagnosing CTEPH in the patients who underwent acute embolic event in the past.

Published
2004
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39. [Infective endocarditis--still a great challenge. Two case reports].

Author

Mazij M, Sobkowicz B, Kosiński M, Kwinecki P, Lenartowska L, Piszko P, Sawa W, Kowal J, and Wrabec K

Subjects
Adult, Aged, Aortic Valve surgery, Endocarditis, Bacterial pathology, Endocarditis, Bacterial surgery, Fatal Outcome, Heart Valve Prosthesis Implantation, Humans, Male, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial therapy
Abstract

We present two patients with aortic valve disease who developed acute infective endocarditis. In both patients the disease started with infection of the upper respiratory tract. The patients were treated with antibiotics due to pneumonia. The diagnosis of infective endocarditis was established 4 months and 9 weeks after the onset of infection. The first patient died whereas the second underwent successful aortic valve replacement.

Published
2004

40. [Acute myocardial infarction in a patient with normal coronary arteries--a case report].

Author

Grabczewska Z, Dybowski J, Sukiennik A, Kubica J, and Wrabec K

Subjects
Aged, Coronary Angiography, Electrocardiography, Female, Humans, Myocardial Infarction diagnosis, Myocardial Infarction diagnostic imaging, Myocardial Infarction physiopathology, Coronary Vessels, Myocardial Infarction etiology, Pacemaker, Artificial adverse effects
Abstract

A case of a 72-year-old female who was admitted for elective dual-chamber pacemaker implantation, is presented. A few hours after the procedure the patient developed chest pain with ST-segment elevation in ECG and a significant increase in the troponin I level. An acute myocardial infarction was diagnosed. Urgent coronary angiography revealed normal coronary arteries without spasm. Possible causes of acute myocardial infarction following pacemaker implantation are discussed.

Published
2004

41. [Effect of a 2-year pulmonary rehabilitation on the 7-year prognosis in patients with advanced chronic obstructive pulmonary disease].

Author

Piszko P, Lewczuk J, Kowalska-Superlak M, Jagas J, Ludwik B, and Wrabec K

Subjects
Adult, Aged, Exercise Therapy methods, Female, Forced Expiratory Volume, Humans, Longitudinal Studies, Male, Middle Aged, Oxygen Consumption, Poland epidemiology, Prognosis, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive epidemiology, Risk Factors, Survival Analysis, Time Factors, Treatment Outcome, Vital Capacity, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Disease, Chronic Obstructive rehabilitation, Quality of Life, Respiratory Therapy methods
Abstract

Pulmonary rehabilitation (PR) improve the quality of life in COPD patients, however, little has been known whether it may improve the survival. We assessed 7-year prognosis in 46 patients with advanced COPD, 27 of which completed successfully 2-year course of PR whereas 19 COPD patients made a control (C) group. At the end of 7-year observation 41.3% of total number of patients survived, among them 12 (42.8%) PR patients and 7 (38%) C patients. COPD progression was the main (80%) reason of mortality in both groups. The survivors had better results of baseline FVC, FEV1 and treadmill exercise test. They did not differ from non-survivors with age, baseline results of the weight, PaO2, PaCO2 and the number of PR patients. The Cox proportional hazard analysis showed that neither of baseline parameters influenced significantly the 7-year prognosis in this group of COPD patients. In conclusion, PR failed to improve 7-year prognosis in the studied group of patients with advanced COPD.

Published
2004

42. [Acute myocardial infarction treated with primary PCI complicated by pulmonary embolism--a case report].

Author

Błaszczyk D, Sobkowicz B, Wysoczański T, and Wrabec K

Subjects
Echocardiography, Electrocardiography, Humans, Male, Middle Aged, Pulmonary Embolism therapy, Angioplasty, Balloon, Coronary adverse effects, Myocardial Infarction complications, Myocardial Infarction therapy, Pulmonary Embolism diagnosis, Pulmonary Embolism etiology
Abstract

A case of 53-year-old male who was admitted to the hospital due to a chest pain, is presented. ECG showed ST elevation in precordial leads. The patient was successfully treated with primary angioplasty. On the third day of hospitalization, he collapsed with hypotension. Routine echocardiographic examination revealed signs of pulmonary embolism. An adequate pharmacotherapy was implemented and the patient improved. After 10 days of treatment and rehabilitation he was discharged home. The present case report points out on pulmonary embolism as a rare but potentially life-threatening complication of coronary angioplasty.

Published
2003

43. [Coronary angiography is not always helpful in differential diagnosis between perimyocarditis and myocardial infarction - four case reports].

Author

Wrabec K, Lenartowska L, Sawa W, Parczewska T, Sukiennik-Kujawa M, Wysoczański T, Babiak I, and Drozdz D

Subjects
Adult, Coronary Vessels pathology, Diagnosis, Differential, Humans, Male, Myocardial Infarction diagnostic imaging, Myocarditis diagnostic imaging, Coronary Angiography methods, Electrocardiography methods, Myocardial Infarction diagnosis, Myocarditis diagnosis
Abstract

Four males aged 17-42 years with ST-T segment changes suggesting perimyocarditis or non-Q acute myocardial infarction are presented. Coronary angiography was performed to establish the final diagnosis. Three patients had normal coronary arteries; two of them had typical clinical signs of perimyocarditis whereas the third patient had less typical changes. The fourth patient was a smoker, had a family history of coronary heart disease and left ventricular dysfunction due to a non-Q wave apical infarction. In this patient coronary angiography revealed small atheromatous plaques in the distal part of left anterior descending artery as well as left main and right coronary artery spasm. Angiospastic aetiology of infarction and probable endothelial dysfunction due to myocarditis were diagnosed. The authors conclude that coronary angiography is not always helpful if clinical, electrocardiographic and biochemical signs of perimyocarditis are observed.

Published
2003

44. [Repeated coronary angioplasty due to restenosis and disease progression - a case report].

Author

Parczewska T, Wysoczański T, and Wrabec K

Subjects
Aged, Angina Pectoris diagnostic imaging, Coronary Artery Disease diagnostic imaging, Coronary Restenosis diagnostic imaging, Coronary Restenosis etiology, Disease Progression, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular surgery, Humans, Male, Radiography, Recurrence, Retreatment, Time Factors, Treatment Outcome, Angina Pectoris therapy, Angioplasty, Balloon, Coronary, Blood Vessel Prosthesis Implantation adverse effects, Coronary Artery Disease therapy, Coronary Restenosis surgery, Stents adverse effects
Abstract

We present a case of a 71-year-old male with exercise angina and two-vessel coronary artery disease (CAD). As the first step of treatment, the patient underwent successful coronary angioplasty with a stent implantation in the circumflex artery and remained free from angina for the following month. After this period, the patient underwent elective angioplasty of left anterior descending (LAD) coronary artery which was complicated by dissection, requiring implantation of two stents. Because of recurrent angina the patient underwent three months later another coronary angiography which revealed in-stent restenosis in LAD. The patient underwent repeated angioplasty with a good angiographic results, however, without cessation of angina Clinical and angiographic indications for percutaneous coronary interventions, according to the recent ACC/AHA guidelines, are discussed.

Published
2003

45. [Electrocardiographic signs of right ventricular overload useful in improving diagnosis of chronic thromboembolic pulmonary hypertension (CTE-PH) in patients with chronic exertional dyspnea].

Author

Lewczuk J, Ajlan AW, Piszko P, Mikulewicz M, Jagas J, Sobkowicz B, and Wrabec K

Subjects
Aged, Chronic Disease, Coronary Artery Disease complications, Coronary Artery Disease diagnosis, Coronary Artery Disease physiopathology, Female, Humans, Male, Predictive Value of Tests, Electrocardiography, Hypertension, Pulmonary complications, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary physiopathology, Hypertrophy, Right Ventricular complications, Hypertrophy, Right Ventricular diagnosis, Hypertrophy, Right Ventricular physiopathology, Pulmonary Embolism complications, Pulmonary Embolism diagnosis, Pulmonary Embolism physiopathology
Abstract

The early recognition of chronic thromboembolic pulmonary hypertension (CTE-PH) is troublesome because of "honey moon" period with chronic dyspnea on exertion as the only one symptom. To find if routine electrocardiography may be useful in improving the diagnosis, value of right ventricular overload (RVO) signs in recognition echocardiographically determined chronic pulmonary hypertension (CPH) and angiographically confirmed CTE-PH in 90 consecutive patients hospitalized due to chronic exertional dyspnea was studied. CPE was found in 76.5% and CTE-PH in 33% of those patients, at least one of twelve founded electrocardiographic signs of RVO was present in 50% patients. The most frequently occurred signs: negative T wave in lead V1-V6, right axis deviation and pulmonale P wave as well as 9 other occurred at frequency below 20% signs of RVO had low to medium sensitivity and negative predictive value and 80-90% positive predictive value for diagnosing CPE and 90-100% positive predictive value for diagnosing CTE-PH. It was concluded that in patients with chronic exertional dyspnea electrocardiographic signs of RVO may be useful in initial diagnosing of CPH and CTE-PH in particular.

Published
2002

47. [Usefulness of two-dimensional echocardiography for evaluation of left ventricular aneurysm. Comparison with magnetic resonance imaging and intraoperative evaluation].

Author

Sobkowicz B, Hirnle T, Harań T, Wrabec K, and Mielecki T

Subjects
Adult, Aged, Echocardiography standards, Female, Humans, Intraoperative Period, Male, Middle Aged, Stroke Volume, Echocardiography methods, Heart Aneurysm diagnosis, Heart Aneurysm surgery, Magnetic Resonance Imaging
Abstract

Unlabelled: Aim of the study was to validate 2D echocardiography (2DE) for quantifying left ventricular aneurysm (LVA). Assessment if the initial parameters of LVA size could predict the choice of surgical technique., Material and Method: Group 1 consisted of 10 patients with LVA who underwent 2DE and magnetic resonance imaging (MRI) as a reference method. Apical 4-chamber plane was used in both techniques to determine LVA area and volume (area-length method). Group 2 consisted of 33 patients with LVA who underwent surgical endoventriculoplasty (EVP): 18 with patch (P), 15 without patch. 2DE was performed before and after surgical procedure. LVA-area, LVA-volume were determined., Results: Group 1 (2DE/MRI): Mean LVA-area and LVA-volume in 2DE were 17.5 +/- 6 cm2 and 62.6 +/- 32 ml, respectively, and in MR, they were 20.9 +/- 7 cm2 and 65.5 +/- 35 ml, respectively. Excellent correlation was found between 2DE and MRI: r = 0.85 for LVA-area and r = 0.81 for LVA volume (p < 0.001). 2DE underestimated LVA measurements in comparison with MRI results. Group 2 (surgical patients): Mean LVA-area was 15 cm2, LVA-volume 50 ml. LVA exceeding 50 ml was considered as large. 2DE LVA size estimation was in agreement with surgical assessment. All but one patient with LVA-volume surpassing 56 ml were operated on with P. EVP without P was done for smaller LVA., Conclusion: 1. With MRI as a reference method, 2DE can accurately quantify LVA size providing information about disturbances in LV geometry. 2. 2DE parameters of LVA-area and LVA-volume are valuable in planning operative method of EVP.

Published
2002

48. [Oxygen saturation at rest, on exercise and during sleep in COPD patients undergoing pulmonary rehabilitation program. Two years prospective controlled study].

Author

Piszko P, Lewczuk J, Kowalska-Superlak M, and Wrabec K

Subjects
Adult, Aged, Exercise Tolerance, Female, Humans, Middle Aged, Prospective Studies, Respiratory Function Tests, Time Factors, Treatment Outcome, Exercise, Oxygen Consumption, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Disease, Chronic Obstructive rehabilitation, Rest, Sleep
Abstract

The role of pulmonary rehabilitation (PR) in COPD patients is well established. However, the PR programs includes physical exercise that may deteriorate chronic hypoxemia. The objective of the study was to evaluate impact of a long term PR program on oxygen saturation at rest, on exercise and during sleep in COPD patients no receiving supplemental oxygenation. A two--year controlled study involved 27 rehabilitated (PR-COPD patients (6 females) aged 32-76 years, mean 58.1 years on average and 19 control (C-COPD patients (3 females) aged 58-83 years, mean 68. COPD patients participating in PR program patients were younger, had higher value of FVC and FEV1 and better results of METs during symptom-limited exercise test (ET, p = 0.007). They also had better results of transcutaneus oxygen saturation (SaO2) at rest (p = 0.02), a lower maximal decrease in SaO2 during ET(p = 0.003) and a higher value of medan SaO2 during (p = 0.02). Following PR program the number of METs achieved during ET increased in PR-COPD patients (p = 0.007) and did not change in C-COPD, p = NS. The SaO2 at rest did not change significantly in both groups. Maximal drop in SaO2 during ET decreased in PR-COPD patients (p = 0.02) and did not change in C-COPD(p = NS) group. Median SaO2 at sleep did not change in PR-COPD patients (p = NS) but it decreased in C-COPD patients (p = 0.02). The study indicates that long term PR does not deteriorate the resting diurnal hypoxaemia, it prevent COPD patients from time depending exacerbation of nocturnal hypoxaemia and can improve oxygen saturation on exertion. The results could be influenced by baseline differences between PR-COPD and C-COPD patients.

Published
2002

49. [Echocardiographic assessment of pathologic geometry in the left left ventricle with aneurysm before and after endoventricular plasty].

Author

Sobkowicz B, Hirnle T, Bross T, and Wrabec K

Subjects
Adult, Aged, Cardiac Volume, Female, Humans, Male, Middle Aged, Polyethylene Terephthalates, Postoperative Period, Echocardiography, Heart Aneurysm diagnostic imaging, Heart Aneurysm surgery, Heart Ventricles diagnostic imaging, Heart Ventricles surgery
Abstract

Unlabelled: Large LV aneurysm (LVA) leads to progressive distortion of ventricular geometry. Endoventricular plasty (EVP) maintains LV original shape and size and may restrain this process., Aims: Echocardiographic estimation of LVA size. Assessment of the results of EVP regarding operative technique. Assessment if the initial parameters of LV function and LVA size could predict the choice of surgical technique., Material and Method: 33 patients with LVA underwent EVP: 18 with patch (group A), 15 without patch (group B). Echocardiography was performed before and after surgical procedure. LVA-area, LVA-volume, its proportion to LV area and volume (LVA-area/LV-EDA, LVA-volume/LV-EDV) were determined apart from routine parameters of LV function., Results: Mean LVA-area was 15 cm2, LVA-volume was 50 mL. Mean LVA-areal LV-EDA was 0.38 LVA-volume/LV-EDV was 0.35. LVA exceeding 0.4 of LV area/volume was considered as a large. After surgery LV-EDV diminished +/- 40 mL, LVLd decreased +/- 1.5 cm. EF improved from 44% to 54%. Patients in group A had larger LVA-volume (60 vs 39 ml, p = 0.02) as well as LV-EDV (160 vs 120 ml, p = 0.03), and lower EF (41% vs 51% p = 0.002). Only 2 patients with LVA-volume greater than 56 ml were operated on without patch. After surgery echocardiographic parameters did not differ between the groups: in group A operation was much more extensive., Summary: 1.) Echocardiographic parameters concerning size (LVA-area, LVA-area/LV-EDA) and volume (LVA-volume, LVA-volume/LV-EDV) of LVA provides information about disturbances in LV geometry, are valuable in planning operative method. 2.) EVP with or without patch provides significant improvement of LV geometry and function in echocardiographic investigation.

Published
1999

50. Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial.

Author

Ceremuzyński L, Budaj A, Czepiel A, Burzykowski T, Achremczyk P, Smielak-Korombel W, Maciejewicz J, Dziubińska J, Nartowicz E, Kawka-Urbanek T, Piotrowski W, Hanzlik J, Cieśliński A, Kawecka-Jaszcz K, Gessek J, and Wrabec K

Subjects
Aged, Cardioplegic Solutions administration & dosage, Drug Therapy, Combination, Female, Glucose administration & dosage, Glucose therapeutic use, Humans, Infusions, Intravenous, Insulin administration & dosage, Insulin therapeutic use, Male, Middle Aged, Myocardial Infarction mortality, Poland, Potassium administration & dosage, Potassium therapeutic use, Prospective Studies, Treatment Outcome, Cardioplegic Solutions therapeutic use, Myocardial Infarction drug therapy
Abstract

We aimed to assess the clinical efficacy of glucose-insulin-potassium (GIK) in acute myocardial infarction. Experimental data provided evidence of the beneficial effects of GIK on ischemic myocardium. The clinical trials, mostly uncontrolled and conducted mainly before the thrombolytic era, were inconclusive due to the small number of patients and discrepancies in protocols. In order to evaluate the efficacy of this intervention, we have performed a prospective multicenter randomized study. The study consisted of 954 patients with acute myocardial infarction (MI) randomized within 24 hours from the onset of symptoms to low-dose GIK (n = 494), which consisted of 1000 mL 10% dextrose, 32-20 U insulin, and 80 mEq K-, or to the control group (n = 460), which was given 1000 mL 0.89% sodium chloride, by intravenous 24-hour infusion at a rate of 42 mL/h. Cardiac mortality and the occurrence of cardiac events at 35 days did not differ between GIK and control-allocated patients (32 (6.5%) vs. 21 (4.6%), respectively; OR 1.45, 95% CI 0.79-2.68, P = 0.20; and 214 (43.3%) vs. 192 (41.7%), OR 1.07, 95% CI 0.82-1.38, P = 0.62). Total mortality at 35 days was significantly higher in the GIK than in the control group (44 (8.9%) vs. 22 (4.8%), respectively, OR 1.95, 95% CI 1.12-3.47, P = 0.01). The excess of non-cardiac deaths in the GIK group may have occurred by chance. Low-dose GIK treatment does not improve the survival and clinical course in acute MI.

Published
1999
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