Mutation A1298C of methylenetetrahydrofolate reductase: risk for early coronary disease not associated with hyperhomocysteinemia.

Diminished activity of 5,10 methylenetetrahydrofolate reductase (MTHFR), a regulatory enzyme of homocysteine metabolism, may predispose to coronary artery disease (CAD). In a case-control study we determined the prevalence of two common MTHFR polymorphisms, C677T and A1298C, in 161 male patients under the age of 50 years with angiographically documented CAD and compared it to that in 211 healthy controls. Genotyping was also performed in a random population sample, consisting of 149 men and 121 women at an average age of 40 years. The studied group had classic risk factors of atherosclerosis but did not differ in fasting plasma homocysteine, folic acid, and vitamin B12 levels in either the control group or population sample. The frequency of the 1298C allele was significantly higher in CAD (0.304) than in controls (0.199) or the population sample (0.235). Allele 1298C showed a significant association with early-onset CAD both in homozygotes and in heterozygous carriers. These findings were further supported by comparisons with the population sample. Homozygosity for allele 677T showed a tendency to associate with CAD. Allele 1298C of MTHFR is associated with early-onset CAD (carriers- RR = 1.71, 95% CI: 1.13-2.59; homozygotes- RR = 3.09, 95% CI: 1.36-7.02), even when blood homocysteine levels are not elevated.

[Congestive cardiomyopathy after a 10-year observation]. / Kardiomiopatia zastoinowa w 10-letniej obserwacji.

A progress in the Polish cardiosurgery promising survival has led to the analysis of patients with congestive cardiomyopathy diagnosed with non-invasive techniques. The study involved 44 patients treated at the III Department of Cardiology in Katowice-Ochojec in 1980-1989. Sixty six percent of these patients were men. Etiology remained unknown in half of them, suggesting the primary cardiomyopathy (group I). As a cause of the secondary cardiomyopathy (group II) infections were considered (bacterial, fungal, and tuberculous), systemic diseases, and ischemic heart disease. Clinical status and results of all non-invasive diagnostic procedures performed since the beginning of therapy to the end of 1989 were analysed. Ultimate examination were performed at the Voivodeship Cardiologic Out-patient Clinic. Dynamics of the disease and effectiveness of the treatment were evaluated. In case of death its direct cause was sought. All results were compared in both groups.

Gutron treatment of patients suffering from essential orthostatic hypotony. Part One--Hemodynamic non-invasive investigation.

Essential orthostatic hypotony (EOH) seems to present a rarely occurring and not well recognized syndrome. Group of 20 patients (pts) with EOH were treated with midodrine (Gutron, Gu) 5 mg i.v. Non-invasive hemodynamic variables, such as systolic time intervals and their derivates, based on polycardiographic recordings, were analysed. Heart rate and blood pressure measurements during orthostatic test were measured before and after Gu administration. The results of the orthostatic trial were compared to the control group of 20 volunteers. In healthy subjects, up-right position resulted in heart rate (HR) acceleration, diastolic blood pressure (DBP), total peripheral resistance (TPR), double and triple product (DP, TP), contraction coefficient (PEP/LVET) and dicrotic coefficient ('d') elevation, prejection period (PEP), electromechanical delay (QS1) and isovolumic contraction time (ICT) prolongation and lastly stroke volume (SV), cardiac output (CO) and middle rate of left ventricle ejection time (MRLVET) reduction. Patients with EOH showed a reduction of the degree of tilt-induced changes of the parameters. DBP fell down. After Gu these unfavourable changes were corrected to the values nearer the control group levels in three compensatory mechanisms. After Gu application in EOH-pts were seen: 1) favourable translocation of the resting (supine) values, but with the same reactivity to tilt, as before Gu (HR, TPR); 2) positive influences on orthostatic reaction, but inversely without any changes of resting values (PEPI, ICT, PEP/LVET, DP, DBP) and finally 3) favourable translocation of resting values together with inversed orthostatic reaction (SBP, QS2,TP). We stated clinical valuable efficacy of Gu. Gu influenced mainly the initial state of circulatory hemodynamics in resting and also in a lower degree in orthostatic reaction.

Gutron treatment of patients suffering from essential orthostatic hypotony. Part Two--Autonomic system investigation.

Neurovegative control of circulatory system in essential orthostatic hypotony (EOH) is not well recognized. Therefore, in group of 9 patients (pts) with EOH treated with midodrine (Gutron, Gu) 5 mg i.v. we performed a study of sympathovagal balance, based on heart rate variability (HRV) analysis. From computer-assisted tachograms we calculated standard deviation of 512 sinus cycles length (SD-SCL) and from power spectral analysis by fast Fourier transformation we derived: amplitudes of high frequency (HF, 0.15-0.35 Hz) and low frequency (LF, 0.05-0.15 Hz) spectra, percentage of power of HF and LF spectra and their ratio, named vegetative control coefficient (VCC, %LF:%HF). Results were compared to that received from control group (11 volunteers). We found that EOH-pts presented lower amplitude of HF, especially after Gu, a lack of increment of %LF irrespective to treatment and higher VCC, which normalized to control value after Gu. We stated that: 1) both branches of autonomic system are disturbed in EOH-patients; 2) Gutron shifts sympatho-vagal balance from initial resting sympathicotomy into parasympathetic predominance.

Gutron treatment of patients suffering from essential orthostatic hypotony. Part Three--Hemodynamic-autonomic interactions.

In this communication neurovegetative investigation of circulatory system in essential orthostatic hypotony (EOH) is continued. Our previous polycardiographic and heart rate variability (HRV) studies showed, that hemodynamic alterations in EOH are concerned with impairment of both branches of autonomic system. But hemodynamic-autonomic interactions in EOH are till now not well recognized. Therefore, in group of 9 patients (pts) with EOH we performed a study before and after midodrine (Gutron, Gu) 5 mg i.v. treatment. Sympathovagal balance, based on heart rate variability (HRV), was analysed in orthostatic trial. Hemodynamic parameters such as: heart rate (HR), systolic and diastolic blood pressure (RRs and RRd), as well as double product (DP) were measured in resting and after tilt. Simultaneously, on basis of computer-assisted tachograms standard deviation of 512 sinus cycles lengths (SD-SCL) was calculated and on basis of power spectral analysis by means of fast Fourier transform, the following variables: amplitudes (absolute powers) of high (aHF, 0.15-0.35 Hz) and low frequencies (aLF, 0.05-0.15 Hz) spectra, percentage powers of HF and LF spectra (%HF, %LF) and their ratio, named vegetative control coefficient (VCC, %LF:%HF). The results were compared to the control group (18 healthy volunteers). We found in EOH-pts significant correlation between aLF and resting HR, whereas after Gu this correlation disappeared and made the reaction of these pts similar to the control subjects, in which these correlations didn't appear. Resting RRs and RRd negatively correlated with aLF in controls, while in EOH-pts this relations were inverse i.e. positive.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term mexiletine treatment of ventricular arrhythmia in patients after myocardial infarction]. / Meksyletyna w dlugotrwalym leczeniu dysrytmii komorowych u chorych po zawale serca.

Eighty two patients with ventricular extrasystole (VES) after myocardial infarction had been treated with antiarrhythmic drugs in the half (41 patients) with mexiletine (M) and in the half (41 patients) with other ones. The mortality rate in the M-group was twice time lower than in the other, however this difference was statistically not significant. M was mostly effective in VES of III and IVb degree after Lown's classification and did not cause any deterioration of the left ventricle function.

Mini set for iontophoresis for topical analgesia before injection.

Findings are reported on a prototype mini set for iontophoresis used to topically anesthetise the puncture spot before injection. The anesthetizing drug applied was a 2% solution of lignocaine which was iontophoresed for 10 min at a current of 1-2.5 mA. Observations were made according to a double-blind trial. After the lignocaine iontophoresis had been performed, 76% of injections were painless and 24% were reported painful. After the placebo iontophoresis, however, 87% of injections were painful. The difference is statistically significant. We conclude that iontophoresis by means of the mini set protects effectively against injection pain. The electronic structure of the device is unique and makes possible safe outpatient use.

Cardiovascular effects of nifedipine--a 4-week treatment in preselected patients with coronary disease.

In 24 patients with coronary ischemic disease the cardiovascular effects of 10-mg tablets of nifedipine given three times daily for 28 days was studied with noninvasive techniques before and after standard work load. Five patients did not complete the study because of drug nontolerance and lack of therapeutic effectiveness. In 19 patients nifedipine has been found to produce positive changes in left ventricle contraction parameters without influencing positively the ECG parameters. An increase in heart rate and the ratio of cardiac oxygen demand to general oxygen consumption was observed. The increase in systolic blood pressure after work load during nifedipine therapy contraindicates use of this drug in cardiac patients with arterial hypertension.