[Primary prevention of ischemic heart disease in middle-aged men living in Prague: results of twenty-year research]. / Primární prevence ischemické choroby srdecní u muzu stredního veku v Praze: výsledky dvacetiletého sledování.

INTRODUCTION: Ischemic Heart Disease (IHD) represents the most frequent cause of mortality and morbidity in the Czech Republic. The aim of this study is to analyze long-term mortality of cardiovascular disease (CVD), identify its predictors and verify the validity of Framingham risk function for Czech patients. DESIGN AND METHODS: The twenty-year study (STULONG) of primary prevention of risk factors of atherosclerosis in 1419 men aged 38 to 53 years living in Prague was started in 1975. RESULTS: CVD mortality analysis showed a higher risk of death for heavy smokers vs. non-smokers or light smokers (p < 0.0001), hypertensive patients vs. patients with normal blood pressure (p < 0.0001), men with hypercholesterolemia vs. men with normal cholesterol level (p = 0.0432), and a lower risk for university graduates vs. men with elementary education (p = 0.0006). Between 1980 and 1984, age-specific CVD mortality rates of men from STULONG study were higher (p = 0.0132) than national CVD mortality rates; between 1985 and 1994, they were insignificantly lower. Framingham risk function underestimated absolute ten-year risk of IHD in all risk quintiles (p < 0.0001) with discrimination of 63%. CONCLUSION: CVD mortality observed within STULONG study was significantly affected by known risk factors (hypertension, smoking, hypercholesterolemia, lower education); Framingham risk function underestimated absolute ten-year risk of IHD.

Primary prevention of coronary artery disease among middle aged men in Prague: twenty-year follow-up results.

BACKGROUND: Coronary artery disease (CAD) represents the most common cause of morbidity and mortality in the Czech Republic. The aim of this study is to analyze long-term cardiovascular diseases (CVD) mortality, identify predictors of outcome and to validate the Framingham risk function in men from the Czech Republic. DESIGN AND METHODS: A 20-year primary prevention study of atherosclerosis risk factors in 1417 men from Prague aged 38-53 years was launched in 1975 (STULONG). RESULTS: When analyzing CVD mortality, heavy smokers had hazard higher than non-smokers and light smokers (p < 0.0001); hypertensives higher than normotensives (p < 0.0001); men with hypercholesterolemia higher than those with normal cholesterol (p = 0.0432), and university-educated men lower than elementary-educated men (p = 0.0006). In 1980-1984, the age specific mortality from CVD in men from STULONG was higher (p = 0.0132) than in the Czech Republic, in 1985-1994 insignificantly lower. The Framingham risk function underestimated the absolute 10-year risk of CAD across the quintile of the risk (p < 0.0001), with 63% discrimination. CONCLUSION: In STULONG, the mortality from CVD was significantly associated with known risk factors (hypertension, smoking, hypercholesterolemia, education); the Framingham risk function underestimated the absolute 10-year risk of CAD.

[The beginnings of electrocardiography at the Prague Medical School]. / Pocátky elektrokardiografie na prazské lékarské fakulte.

The authors describe the beginnings of development of electrocardiography at the Prague Medical Faculty of Charles-Ferdinand and Charles University resp. The first results of the new method came from the physiological laboratory of Ewald Karl Konstantin Hering (1834-1918), who contributed to electrocardiography by explaining the mechanism of atrial fibrillation and to Richard Hans Kahn (1876-1941) who was the first to publish electrocardiographic changes after temporary block of coronary artery blood flow in the dog. Clinical application and the promotion of electrocardiography in this country is among others in particular from Václav Libenský (1877-1938), Klement Weber (1890-1971) and Frantisek Herles (1900-1991) whose name became for half a century the synonym for electrocardiography.

[ECG mapping in clinical practice]. / EKG mapování v klinické praxi.

First the authors present a review of important cornerstones in the history of the electrocardiogram (ECG) and ECG mapping. The first to describe the electric cardiac field based on twenty ECGs was A.D. Waller in 1889. The decisive cornerstone for practical use was the introduction of a string galvanometer in 1901 by W. Einthoven and his triaxial lead system. Another very important cornerstone in the development of ECG were the findings of F.N. Wilson. Merits as regards the development and application of ECG mapping are due to B. Taccardi. Workers of the Second Medical Clinic in Prague enhanced after 15 years of studies and comparison of ECG maps with coronarographic findings in subjects with ischaemic heart disease (IHD) and microvascular coronary dysfunction (syndrome X--SyX) substantially the specificity of this method in impaired myocardial vascularization. Better diagnosis was achieved by introduction of diagnostic tests which influence coronary vascularization such as e.g. hyperventilation, as well as other tests. After their application progression of chronic myocardial ischaemia occurs, e.g. by the mechanism of the "steal phenomenon" or restriction of the microcirculation after hyperventilation in patients with SyX. Furthermore the authors present examples of ECG maps after PTCA, after application of diagnostic tests in IHD and SyX and also regression of myocardial ischaemia after marked reduction of total cholesterol.

Relevant information for decision support systems: application in cardiology.

In the paper we show information theory tools for extracting relevant information for decision support systems from medical databases. Each proposed algorithm for selecting a set of relevant features has a specific score function defined by means of information-theoretical characteristics. Then algorithms are classified according to the primary criterion, that can lead to influence-preferring algorithms or weight-preferring algorithms. Other type of classification can be based on the way of selecting of features as forward, backward or combined algorithms. The software package called CORE (COnstitution and REduction) that supports the process of selection of features relevant for a decision making problem is described. Application on data about 1417 middle age men collected in the twenty years lasting interventional study of cardiovascular risk factors in middle aged men and for decision support in primary care are shown. However, the methodology presented is applicable for any decision making problem where extracting relevant information from data is required.

Evaluation of data in cardiology by new software tools.

We describe an analysis of cardiology data using new software tools. First we use data of 1417 men aged 40 to 50 years living in the center of Prague gathered in the twenty years lasting longitudinal study. We show some results of application of the programs E.T. (Epidemiology Tools) and CORE (COnstitution and REduction of data). Second we show the way of application of the program HYPERTENSION, that supports decision making in therapy of arterial hypertension.

Decision support and data analysis tools for risk assessment in primary preventive study of atherosclerosis.

In the paper we show results of two programs applied for data analysis and decision support in primary preventive study of atherosclerosis. First program E.T. (Epidemiology Tools) can be used for analysis of data from retrospective (case-control) studies, prospective (cohort) studies and for standardization. Second program called CORE (COnstitution and REduction) supports the process of selection of features that are relevant for given decision making task. Program CORE is using information theory approach. Both these programs were applied to analysis of data about 1417 middle age men collected in the longitudinal study on atherosclerosis in urban population. Apart from these two new programs we have analyzed data also by the STATISTICA software.

Evaluation of body surface potential mapping changes after successful percutaneous transluminal coronary angioplasty.

OBJECTIVE: To assess the progress of chronic myocardial ischemia after successful percutaneous transluminal coronary angioplasty (PTCA) using body surface potential mapping (BSPM). DESIGN: For BSPM analysis the following kinds of maps were used: isopotential repolarization maps corresponding to 70% of ST-T interval's duration and isointegral maps corresponding to 0% to 20% of ST-T duration. BSPM measurements were taken before the PTCA and usually one to six days after this intervention. In 17 patients BSPM was carried out within two days after PTCA. Eleven to 14 BSPM examinations were usually carried out during six months of follow-up. Control coronary angiography was performed after six months in all but three patients. RESULTS: Substantial focal decrease of positive potential in repolarization caused by myocardial ischemia recovered gradually after successful PTCA. This appeared to be caused by the regression of "hibernating myocardium'. An increase of positive potential was statistically significant (P < 0.01) after the fifth week of PTCA intervention. There was a positive correlation between BSPM findings and chest discomfort of patients after PTCA. Chronic myocardial ischemia could be observed on isopotential and/or isointegral maps examined before the PTCA in 21 of 25 cases (sensitivity 84%).

[Survival in patients after surgical closure of post-infarction rupture of the ventricular septum]. / Prezívání nemocných po chirurgickém uzáveru poinfarktové ruptury mezikomorové prepázky.

The authors discuss in the introduction hitherto reported data on the incidence and course of post-infarction ruptures of the interventricular septum and the results of conservative treatment. The high mortality rate after the conservative procedure led to attempts to resolve post-infarction ruptures of the interventricular septum surgically. The authors discuss in detail the indications for early and delayed operations has a decisive influence on the patients' survival. The authors had the opportunity to operate since 1978 till February 1986 five patients with post-infarction perforation of the interventricular septum. Four of the patients were women, one was a man. The mean age of the operated patients was 61 years, the oldest patient was a 75-year-old man and the youngest a 46-year-old woman. During the last check-up in 1994 it was revealed that of five operated patients three had died. One of them three years after operation and two after seven years. One female patient survives for 13 years and one for 11 years. Both are in a satisfactory conditions.

The methodology of clinical analysis of electric heart field.

A brief description of the methodology of analysis of the electric heart field using electrocardiograms, vectorcardiograms, diagrams of potential maxima/minima and body surface potential maps is presented. The text is focused on the description of different kinds of isopotential and isointegral maps and their diagnostic possibilities. A detailed description of the diagram of potential maxima/minima and its place in diagnostic of different disturbances of the heart muscle and conduction defects is given.

[Diagnosis of conditions following myocardial infarct using complex analysis of electrical cardiac fields]. / Diagnostika stavu po srdecním infarktu komplexní analýzou elektrického srdecního pole.

In 22 patients with ischaemic heart disease and conditions after infarction and angina pectoris a coronarographic examination was made as well as other auxiliary examinations incl. a complex analysis of the electrical cardiac field (KAESP) (23), using a Cardiac apparatus (manufacturer ZPA Cakovice). Using the KAESP method fibroses in the heart muscle were found in all 22 patients, while a classical electrocardiogram revealed them only in 12 patients (54.5%). Post-infarction fibrous changes on the inferior cardiac wall were detected by ECG in 10 patients, KAESP revealed this localization of changes in 17 patients. The difference was particularly marked as regards localization on the anterior cardiac wall, according to ECG it was in 2 patients, according to KAESP in 17 patients. The authors investigated also on isopotential repolarization maps focal changes caused by cardiac ischaemia associated with organic affection of the appropriate coronary artery as revealed by coronarography. Identical sites were proved in 18 patients by the two methods, i. e. in 81.8%. In the discussion the authors analyse the causes which influence the accuracy of assessment of the coronary artery in KAESP. In KAESP in addition to isopotential maps also other maps were used such as isointegral, iso-areal, asynchronic potential maxima and minima, isochronic maps, maps of negative isodivergencies, profile sections etc. (20).

[Diagnosis of syndrome X using comprehensive analysis of the electrical field of the heart]. / Diagnostika syndromu X komplexní analýzou elektrického srdecního pole.

The authors describe the clinical picture and results of some auxiliary examinations in 18 patients with the X syndrome, i.e. with angina pectoris with a normal angiographic finding on the coronary arteries. For the diagnosis of ischemic cardiac changes, which are an integral part of this syndrome, the authors used a complex analysis of the electric cardiac field by means of a Cardiac 128.1 apparatus (manufactured by ZPA-Cakovice). In patients with the X syndrome they observed a significant reduction of some potential and integral values, as compared with an equally sized group of healthy subjects. On maps of the electric manifestation of cardiac activity on the chest surface ischemic changes were revealed on the antrior and lower cardiac wall but also in its lateral and posterior wall. These changes were older and were found in the subendocardial layer or concurrently in another area of the heart with affection of the subepicardial layer. Minor non-transmural fibroses, most frequently on the septum, in some instances spreading to the anterior and lower cardiac wall, were a surprising finding. At present it is not possible to differentiate merely by analysis of the electric cardiac field the X syndrome and ischemic heart disease. This should be made possible by further comparative studies. The present paper is the first description of ischemic and fibrous cardiac changes in X syndrome diagnosed by a complex analysis of the electric cardiac field in the professional literature published in Czechoslovakia and other countries.

Percutaneous laser angioplasty with a pulsed Nd:YAG laser. Initial clinical experience and early follow-up.

Percutaneous laser-assisted balloon angioplasty with a pulsed Nd:YAG laser coupled to sapphire tipped optical fibers was used for the treatment of 22 patients presenting with 30 chronic occlusions of peripheral arteries (mean length 11 cm) during 25 sessions. The procedure was completed by balloon dilatation in 67%. Successful recanalization was achieved in 92%, clinically the procedure was successful in 68% with mean ABPI increase from 0.43 +/- 0.13 to 0.79 +/- 0.21. In 8 cases complications occurred. Two reocclusions were treated by streptokinase infusion, and 2 procedures were repeated 2 months later, one patient was referred to elective bypass surgery, and 3 patients were treated conservatively. Six patients were followed-up for more than 6 months. In 1 patient claudication of 400 m reappeared. These results are encouraging and it is likely that this method could become an important adjunct to balloon angioplasty.

[Is the argon laser suitable for angioplasty procedures?]. / Je argonový laser vhodný k angioplastickým výkonum?

Laser angioplasty is a perspective method for the treatment of complications of atherosclerosis of peripheral and coronary arteries. The present study deals with the effects of an argon laser on cadaverous coronary arteries with atherosclerotic plaques. Radiation of the argon laser created in the plaque a circular defect with a singed margin. The energy of radiation being equal, the size of the defect depended on the position of the optic fibre -- it was greatest when the optic fibre was in contact with the plaque. The defect thus formed had uneven margins with adjacent layers of thermal damage which were larger in calcified plaques than in fibrous and fibrolipomatous plaques. Penetration of radiation into the plaque depended on its composition -- being least in calcified plaques. When the arteries were rinsed with saline during irradiation, the effect of radiation on the tissue was reduced as the tissue was cooled. The argon laser causes greater thermal damage of the arteries than pulsed lasers and therefore its clinical application will be restricted.