Vane blood-bathed technique reveals the significance of adrenergic reaction in myocardial infarction.

Using the blood-bathed technique of Vane we induced acute coronary occlusion in the dog and subsequently detected adrenaline release into the circulatory system, determined the rate of release and documented its significance for induction of cardiac arrhythmias. In the intact anesthetized dog, adrenaline excess of the magnitude released after coronary occlusion was sufficient to injure the healthy myocardium and to induce unfavorable metabolic systemic alterations. Subsequently, clinical research has documented that a serious clinical course of acute myocardial infarction is associated not only with enhanced excretion of catecholamines but also with augmentation of plasma renin activity and aldosterone levels. The positive therapeutic effect of aldosterone antagonists in acute myocardial infarction has been documented. The clinical value of our results, which were obtained in experimental and clinical studies, was later confirmed in multi-center trials.

Effects of vitamins C and E on the outcome after acute myocardial infarction in diabetics: a retrospective, hypothesis-generating analysis from the MIVIT study.

BACKGROUND: There is significant evidence that reactive oxygen species play an important role in endothelial dysfunction, ischemia/reperfusion injury as well as in the pathogenesis of diabetes mellitus (DM). It is also known that vitamins C and E have substantial antioxidant properties. However, clinical evidence concerning this topic is insufficient so far. The aim of the present study was to determine if the administration of vitamins C and E influences the outcome in diabetic patients with acute myocardial infarction (AMI). METHODS: Among 800 patients with AMI included in the MIVIT (Myocardial Infarction and Vitamins) study, 122 patients (15%) had confirmed DM. A retrospective analysis of the influence of vitamins C and E on 30-day cardiac mortality in patients with or without DM was performed. RESULTS: There was a significant reduction in 30-day cardiac mortality in diabetic patients treated with antioxidant vitamins C and E [5 (8%) vs. 14 (22%); OR 0.32, 95% CI 0.11-0.93; p = 0.036]. Such an effect has not been observed in patients without DM [19 (6%) vs. 19 (6%); OR 0.97, 95% CI 0.51-1.85; p = 0.94]. CONCLUSION: The results suggest that early administration of antioxidant vitamins C and E in patients with AMI and concomitant DM reduces cardiac mortality.

Association between carotid artery atherosclerosis and coronary artery disease in young females. Reference to sex hormone profile.

BACKGROUND: Atherosclerosis of coronary and peripheral arteries occurs rarely in premenopausal women. It has been postulated that sex hormones protect the vascular wall. AIM: To evaluate whether ultrasound assessment of the changes in the wall of carotid arteries provides any useful information on the severity of atherosclerosis of the coronary vessels as well as whether the atherosclerotic changes in the wall of carotid arteries are accompanied by oestrogen insufficiency in the premenopausal age. METHODS: The studied group consisted of 65 regularly menstruating women: 21 with coronary artery disease (CAD) revealed by angiography or after myocardial infarction (mean age 44 years)--the CAD group; and 44 healthy woman (mean age 43 years)--the control group. The severity of atherosclerotic changes was determined based on computer-assisted measurement of the intima-media complex thickness (IMC-T) in the common carotid artery. In all women prospective measurement of sex hormone profile was done with enzymatic immunoassay: oestradiol at day 7-9 and day 19-21 of the menstrual cycle and follicle-stimulating hormone (FSH). RESULTS: The IMC-T value was greater in the CAD group than the control group (0.696+/-0.124 mm and 0.518+/-0.064 mm respectively, p=0.001). The IMC-T (>0.6 mm) was a good indicator of the occurrence of CAD (OR 15.6, 95% CI 3.65-71.1, p <0.0001), with a sensitivity of 73.7% and a specificity of 84.8%. There was a negative correlation between oestradiol level at day 19-21 of the menstrual cycle and IMC-T (r=-0.28, p=0.05). CONCLUSIONS: The IMC-T value >0.6 mm was found to be a sensitive and specific ultrasound parameter that can be useful in detecting the presence of CAD in premenopausal women. The results of the study also suggest a possible association between hormonal profile and early atherosclerotic changes in carotid arteries in premenopausal women.

Risk factors of atherosclerosis in premenopausal women with a sense of well-being. A pilot study.

INTRODUCTION: Women before menopause are thought to be relatively safe from cardiovascular disease due to the protective effects of oestrogens, although one may question this opinion with regards to women with many typical risk factors. However, because of the shortage of data concerning prevalence of risk factors in young women, it is not known whether this phenomenon is confined to a limited group or affects many women. AIM: The purpose of this study was to determine the prevalence of either typical risk factors of atherosclerosis or emotional disturbances that might increase the probability of coronary artery disease in young women. METHODS: The study group involved 62 premenopausal women with a sense of well-being (regular menstruations, activity of serum follicle stimulating hormone < 15 IU/L). Mean age of women was 43.5 years. Total cholesterol, LDL and HDL fractions, triglyceride, lipoprotein (a) and homocysteine concentrations were examined and body mass index was calculated. A psychological examination assessing depression and neuroticism intensity was also performed. RESULTS: Total cholesterol concentration (mean values +/- SD, expressed as mg%, percentage of abnormal results are given in brackets) was 206.3+/-35.8 (67.2), LDL cholesterol 124.3+/-30.2 (55.1), HDL cholesterol HDL 62.5+/-14.8 (6.9), triglyceride 101+/-60.1 (13.8), lipoprotein (a) 18.9+/-17.5 (44.8). Body mass index was 25.2+/-4.1 (41.3). History of smoking was positive in 27.4% and 6.5% of examined women had arterial hypertension. Coexistence of 4 to 5 aforementioned risk factors was noted in 27.4% of studied subjects. Mean homocysteine concentration was 10.7+/-2.1 micromol/L, while 41.3% of subjects had levels above the threshold of 11 micromol/l, commonly considered pathological. Symptoms of depression and neuroticism were seen in 30.5% and 22.5% of women, respectively. CONCLUSIONS: This pilot study of young women demonstrated that, in contrary to popular belief, this population is vulnerable to cardiovascular disease due to high prevalence of many risk factors.

Low serum triiodothyronine in acute myocardial infarction indicates major heart injury.

AIMS: In patients with acute myocardial infarction (MI), low serum triiodothyronine (T3) concentration is commonly associated with a severe clinical course. The aim of this prospective study was to investigate whether a severe clinical course in patients with low T3 is related to the magnitude of myocardial injury assessed by echocardiography. METHODS AND RESULTS: Out of 635 patients with MI we enrolled 100 consecutive patients. They were divided in two subgroups: group A, 81 patients without clinical hard events (death, resuscitation following ventricular tachycardia/vertricular fibrillation, new MI) and group B, 19 patients in whom at least one of the above hard events occurred during hospital stay. Thyroid function tests were performed on day 1, 4 and 7, echocardiographic examinations measuring asynergic area (AA), and wall motion score index (WMSI) between day 1 and 5 (median 3). A negative correlation was found between plasma free triiodothyronine (FT3), concentration and AA (p<0.001), FT3 and WMSI (p<0.001) values at all time points. FT3 concentration was lower in group B than group A at all time points (p<0.001). CONCLUSIONS: In patients with acute MI, low FT3 state is related to the extent of myocardial damage.

L-arginine supplementation prolongs exercise capacity in congestive heart failure.

BACKGROUND: In congestive heart failure (CHF), endothelial dysfunction may contribute to impairment of exercise induced vasodilatation and decreased exercise capacity. We hypothesised that administration of L-arginine, a precursor of nitric oxide (NO) and postulated antioxidant, may improve endothelium-dependent vasodilatation and exercise capacity and also exert antioxidant activity. AIMS: To investigate the effect of oral supplementation with L-arginine on exercise capacity and markers of oxidative stress in patients with mild to moderate CHF. METHODS: The study had a randomised double-blind cross-over design. Twenty one patients with stable NYHA II-III CHF underwent three exercise tests: initially, after oral administration of L-arginine (9 g/day for 7 days) or placebo. Blood was sampled prior to each test for plasma lipid peroxides, reduced sulphydryl groups and leukocyte oxygen free radical production. RESULTS: We found a higher prolongation of exercise duration time after L-arginine than after placebo (99+/-106 vs 70+/-99 s, p<0.05). There were no significant differences in markers of free radical activity. CONCLUSIONS: In patients with chronic stable CHF, oral supplementation with L-arginine prolongs exercise duration which may be due to NO-induced peripheral vasodilatation. The antioxidant properties of L-arginine have not been confirmed in this ex vivo study.

Lipid profile during the first 24 hours after myocardial infarction has significant prognostic value.

AIMS: A high level of total cholesterol and LDL-cholesterol disturbs the endothelial function. Thus it can be expected, that hypercholesterolaemia may unfavourably influence the course of the acute myocardial infarction. The aim of the study was to check whether patients with lipid levels above normal during the first hours of myocardial infarction have an unfavourable clinical outcome. METHODS AND RESULTS: The study group consisted of 348 patients (216 males, aged 65.7+/-12 years) with acute myocardial infarction hospitalized up to 24 hours after the onset of symptoms. Blood samples for lipid profile were taken on the first day of hospitalization, in the morning, while fasting. 109 (31%) patients had a complicated in-hospital course of infarction (i.e. death, recurrent ischaemia, serious arrhythmias and/or conduction disturbances, heart failure). The total cholesterol and LDL-cholesterol levels were higher in the patients with complicated than in the patients with uncomplicated clinical course of infarction: 243+/-40.7 vs 211.2+/-40.6 mg/dl, p<0.001 and 156+/-35.0 vs 132.6+/-35.2 mg/dl p<0.001, respectively. CONCLUSIONS: Higher levels of total cholesterol and LDL cholesterol during the first 24 hours of acute myocardial infarction have a strong negative prognostic value, what suggests the use of statins as early as possible in acute myocardial infarction.

Prognostic value of exercise-induced QT dispersion in patients after acute myocardial infarction.

BACKGROUND: Electrocardiographic exercise tests are widely recommended for patients before discharge after myocardial infarction, what justify the search for new variables which may improve their prognostic value. QT dispersion in 12 lead ECG reflects the heterogeneity of ventricular repolarisation. Increased QT dispersion is a noninvasive marker of ischaemia and electrical instability. AIM: Evaluation of the prognostic value of exercise-induced changes of QT dispersion in patients after an acute myocardial infarction. METHODS: Heart rate limited treadmill exercise test according to modified Bruce was performed 14+/-5 days after infarction in 77 patients (age 56+/-11,8 female). QT dispersion was measured at rest and on peak exercise. Patients were followed up for mean 88 months. RESULTS: QT dispersion was higher at peak exercise in those patients who died due to cardiovascular causes (n=8) or suffered from non-fatal myocardial infarction during follow-up (n=15), than in remaining group (71+/-20 vs 58+/-22 msec, p<0.01). At rest QT dispersion was similar in both groups (64+/-17 vs 66+/-20 msec, NS). CONCLUSIONS: The lack of an exercise-induced decrease in QT dispersion identifies a subgroup of patients after myocardial infarction with a poor long-term prognosis.

Acute coronary syndrome: potassium, magnesium and cardiac arrhythmia.

BACKGROUND: Cardiac arrhythmia is often present in patients with acute coronary syndrome (ACS) and may be due to the electrolyte imbalance. AIM: To assess the prevalence and clinical significance of electrolyte imbalance in ACS. METHODS: Serum potassium and magnesium levels were measured within the first few hours in 204 consecutive patients with ACS admitted to our department over a period of 23 months. Cardiac arrhythmia was documented using continuous ECG monitoring, telemetry or standard ECG. RESULTS: Hypokalemia was observed in 34% of patients, and was significantly associated with the occurrence of life-threatening ventricular arrhythmias (26% of patients with potassium level <4 mmol/l vs 11.9% of patients with normokalemia, p<0.001). No relationship was found between potassium level and supraventricular arrhythmias or in-hospital mortality. Decreased magnesium serum concentration was found in 22% of patients but was not significantly associated with cardiac arrhythmias or mortality. CONCLUSIONS: Hypokalemia and hypomagnesemia are often present in patients with ACS. The former is associated with dangerous ventricular arrhythmias. Early assessment of electrolyte serum concentration is needed in order to implement proper supplementation.

Is preinfarction angina associated with better outcome after myocardial infarction?

BACKGROUND: In a clinical setting of acute myocardial infarction (MI), short-lasting and transient anginal pain, preceding the development of acute MI, is regarded as a symptom representing ischaemic preconditioning. Some experimental and clinical data suggested that preinfarction angina may favourably influence the course of acute MI. AIM: We sought to examine the hypothesis that preinfarction angina occurring within 24 hours prior to the onset of acute MI favourably influences the outcome. METHODS: The study group consisted of 331 patients who were admitted to our hospital due to acute MI with ST segment elevation with a symptom duration <12 hours and received thrombolysis. Preinfarction angina within 24 hours prior to MI was present in 80 patients whereas the remaining 251 patients had no chest pain preceding acute MI. The course of the in-hospital phase of MI (mean 15 days) was analysed. RESULTS: In patients with preinfarction angina the in-hospital complication rate was significantly lower than in patients without angina preceding acute MI (p<0.001). Patients without preinfarction angina more frequently developed heart failure (p<0.001) or died (p<0.01) in hospital. Patients with preinfarction angina had significantly less extensive MI and had reperfusion symptoms more frequently. Multivariate analysis showed that there were three factors which independently favourably influenced survival: preinfarction angina (p=0.01), age < or =65 years (p=0.04) and duration of chest pain during acute MI < or =3h (p=0.03). Of the analysed group, 73 patients died in hospital. The independent variables predicting death included prior MI (p=0.04), history of diabetes (p=0.02), acute left bundle branch block (p=0.01) and age >65 years (p=0.03). Non-fatal re-infarction complicated the in-hospital course of MI in 27 patients. The independent variables which predicted this complication included age >65 years (p=0.03) and hypercholesterolemia (p=0.04). CONCLUSIONS: Patients with preinfarction angina, occurring within 24 hours of acute MI, have better in-hospital outcome and less extensive myocardial injury than patients without antecedent angina. These results may be attributed to the protective effects of ischaemic preconditioning.

Antioxidant vitamins decrease exercise-induced QT dispersion after myocardial infarction.

BACKGROUND: Antioxidant vitamins C and E inhibit neutrophil-mediated production of free radicals in acute myocardial infarction (MI) which may limit MI size and improve myocardial perfusion. AIM: To examine whether treatment with vitamin C and E reduces inhomogeneity of repolarisation in patients with acute MI. METHODS: In this double-blind, placebo-controlled randomised trial 37 patients with acute MI were enrolled and assigned to vitamin C and E (600 mg/day each) or placebo treatment, starting on the first day of acute MI and lasting for 14 days. Inhomogeneity of repolarisation was assessed by examining QT interval dispersion (QTd), measured both at rest and at the end of sub-maximal exercise test, performed before discharge. RESULTS: Baseline QTd was similar in both groups, however, exercise-induced QTd was significantly lower in patients treated with antioxidant vitamins compared with the placebo group (59 +/- 20 msec vs 74 +/- 24 msec, p<0.05).

Intravenous amiodarone for cardioversion of recent-onset atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is one of the most common causes of hospital admission, with a prevalence of up to 5% of the population, increasing with advancing age. Emergency direct current cardioversion is the therapy of choice when arrhythmia leads to hemodynamic compromise, but in patients who are hemodynamically stable, antiarrhythmic drugs are usually given to restore sinus rhythm. HYPOTHESIS: The study was undertaken to assess the efficacy of intravenous amiodarone in cardioversion of recent-onset paroxysmal atrial fibrillation (AF). No standard antiarrhythmic therapy has been accepted for pharmacologic cardioversion of AF. Amiodarone seems to be a promising candidate, but only few randomized trials are available and the results are inconsistent. METHODS: In all, 160 patients with AF lasting < 24 h were randomly assigned (2:1 fashion) to the amiodarone group (n = 106) receiving 5 mg/kg as a 30 min intravenous (i.v.) infusion, followed by i.v. infusion of 10 mg/kg during 20 h diluted in 1000 ml of 10% glucose with 20 IU of rapid-action insulin, 80 mEq of potassium chloride, and 8 g of magnesium sulphate (GIKM), or to the control group (n = 54) receiving 1000 ml of GIKM alone. Treatment was continued up to 20 h independent of sinus rhythm restoration. RESULTS: Sinus rhythm was restored 20 h after initiation of therapy in 88 (83%) patients in the amiodarone group and in 24 (44%) patients in the control group (p < 0.0001). The difference between efficacy of the two treatment modalities became significant already after 8 h of therapy (53 vs. 14 patients with sinus rhythm, respectively, p < 0.05). The mean dose of amiodarone administered until sinus rhythm restoration was 740 +/- 296 mg. The presence and the type of underlying heart disease did not influence the conversion rate in either group. In two patients (1.8%) treated with amiodarone, the return of sinus rhythm was preceded by asystole. CONCLUSION: Amiodarone is effective in the termination of AF lasting < 24 h. It may be particularly useful in patients with organic heart disease in whom class I antiarrhythmic agents may be contraindicated. During treatment, the heart rhythm should be monitored continuously.

[Hypertension and metabolic syndrome in population of one company. Monotherapy with amlodipine and doxazosin]. / Nadcisnienie tetnicze i zespól metaboliczny w populacji jednego zakladu pracy. Monoterapia amlodypina i doksazosyna.

UNLABELLED: In Poland diagnosing of hypertension (HA) and the efficacy of treatment of this condition is still insufficient. Consideration of the concomitant metabolic disorders may help to choose the best line of therapy. AIM OF THE STUDY: To determine the incidence of HA and concomitant lipid and carbohydrate metabolism disturbances in population of one company. To assess the efficacy of monotherapy of HA and the influence of therapy on some metabolic parameters. METHODS: The blood pressure was measured in 599 subjects. Patients with HA (> or = 140/90 mmHg) were treated according to metabolic parameters. Patients with fasting total cholesterol (TC) > or = 200 mg% and/or fasting glucose level > or = 110 mg% received doxazosin (D); initial dose 1 mg. The remaining patients received amlodipine (A); initial dose 5 mg. RESULTS: HA was found in 154 patients (27.5%). In this group, 50 of subjects were unaware of the disease, the remaining 67 (44%) were not treated or treated insufficiently. Elevated glucose and/or TC levels were found in 51% of hypertensives. After one month of treatment with A or D, the mean systolic and diastolic blood pressure decreased significantly (p = 0.001). Monotherapy was effective in 88.9% of subjects in group D and in 92.1% in group A. In group D, TC concentration decreased by 9.5% comparing to baseline (p = 0.001). The tolerance of treatment was similar in both groups. CONCLUSIONS: One fourth of the examined company population under medical attention of the local health service had HA. One third of HA patients were unaware of the disease. The half of patients with HA had metabolic disorders. Doxazosin and amlodipine were equally effective and well tolerated during one month of treatment. Treatment with doxazosin positively influenced the metabolic profile.