[Primary PTCA in the treatment of acute myocardial infarct. Experience at the Faculty Hospital in Hradec Kralove]. / Primární PTCA v lécbe akutního infarktu myokardu. Zkusenosti ve FN Hradec Králové.

INTRODUCTION: Primary coronary angioplasty is at present a fully accepted and worldwide method of treatment of acute myocardial infarction. As proved by a number of randomized studies, this treatment is associated with a higher rate of coronary patency, a smaller infarction focus an better clinical results as compared with thrombolytic treatment. METHOD: The authors analyzed a register of 233 consecutively treated patients with primary coronary angioplasty in the Faculty Hospital in Hradec Králové with elevation of the ST sections on electrocardiographic examination during the period from September 1997-January 2001. RESULTS: Acute success defined as a residual stenosis < 30%, normal flow through the vessel (TIMI III) and survival for the first 24 hours was 91.0% and without patients with cardiogenic shock even 96.0%. The total mortality on hospitalization was 9.1%. The mortality of patients without cardiogenic shock was only 1.9%. A high mortality was recorded in patients in cardiogenic shock (74.0%). A stent was implanted in 65.0% patients, subacute thrombosis of the stent occurred in 1.9%. During a 6-month follow up the total mortality was 10.3%. The percentage of patients without any cardiovascular even (event free survival, EFS) after discharge from hospital was 81.0%. CONCLUSIONS: The authors provided evidence that primary coronary angiolpasty is a safe and highly effective method in the treatment of acute myocardial infarction. It is associated with a total hospitalization mortality of ca 10% and a mortality of less than 2% in patients without cardiogenic shock. Cardiogenic shock, on the other hand, remains a problem despite intensive treatment such as inotropic support, mechanical reperfusion and intraortal balloon counterpulsation. In the presented work the mortality of patients with cardiogenic shock was 74.1%. Implantation of a stent does not involve a major risk for the patient, the incidence of subacute thrombosis of the stent is low and does not differ from elective procedures. The fate of patients during the follow up after primary angioplasty is favourable. In the presented work the total 6-month mortality was 10.3% and EFS was 81.0%.

Bioanalysis of PUFA metabolism and lipid peroxidation in coronary atherosclerosis.

Twenty eight men (age 34-77 years) who underwent an elective coronary angiography for coronary artery disease (CAD), were studied. They were divided into group A (luminal narrowing < 50%; n = 11) and group B (luminal narrowing > 50%; n = 17). Capillary gas chromatography was used for determination of fatty acids. Retinol and alpha-tocopherol were analyzed by reversed-phase high-performance liquid chromatography (HPLC), other parameters were determined spectrofluorometrically and spectrophotometrically. Severe coronary atherosclerosis in group B was associated with higher serum low density lipoprotein/high density lipoprotein (LDL/HDL) cholesterol ratio, triacylglycerols, and phospholipids (P < 0.05). Erythrocyte membrane fatty acids C14:0, C16:1 and C22:6n3 were significantly higher in group B (P < 0.05). We found significantly higher plasma polyunsaturated fatty acids (PUFA) C18:3n6 in group B, whereas plasma linoleic acid was not changed significantly. There was a significant increase of IDL-C18:0, LDL-C14:0 and HDL-C22:6n3 PUFA in group B. We conclude that disturbances in saturated fatty acids (SUFA) and PUFA metabolism are associated with coronary atherogenesis. Such abnormalities may include enhanced extrahepatic transport of C14:0 SUFA via LDL and its incorporation into cell membranes, and enhanced clearance of anti atherosclerotic C22:6n3 PUFA via serum HDL.

[Percutaneous rescue transluminal coronary angioplasty]. / Záchranná (rescue) perkutánní transluminální koronární angioplastika.

Rescue angioplasty is an operation performed in the acute stage of myocardial infarction where systemic thrombolysis did not lead to opening of the artery. Investigations made in recent years indicate the benefit of rescue angioplasty only in those patients where the infarcted artery is patent several hours after evidence that thrombolysis failed. At the same time they provide evidence of the increasing safety and technical success of the operation. The authors present a brief review of the literature pertaining to the development of views, and emphasize the need of early and correct indication.

[Changes in platelet activity in invasive cardiologic procedures]. / Zmeny aktivity desticek pri invazivních kardiologických výkonech.

The authors revealed some changes in the platelet activity in patients with invasive cardiological procedures. Changes of the platelet function were manifested by an enhanced aggregation of platelets in vivo, an increased secretion from alpha granules and increased release of prostaglandin metabolites from platelets and from the vascular wall. Acetylsalicylic acid (ASA) suppressed the formation of circulating platelet aggregates in vivo, but the platelet activity was manifested by another mechanism, independent on ASA. The authors recorded therefore an increase of prostaglandin metabolites and PF4 even in patients who were treated with ASA before the invasive examination.

[The clinical picture of stenoses of the trunk of the left coronary artery]. / Klinický obraz stenózy kmene levé vencité tepny.

In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive only in complete obstruction of the left coronary, in case of multiarterial affection almost in all cases. Coronarography revealed only in 4 patients (9%) isolated stenosis of the trunk of the left coronary, most frequently the finding was also on two other (36.4%) or 3 (34.1%) arteries. Complete occlusion of the trunk of the left coronary was recorded in 6.8%. An ejection fraction of 50% or more was recorded in 75% of the patients. Surgical revascularization was performed in 35 patients. Twenty-nine patients are followed up after operation on a long-term basis (on average for 7.8 months), 23 of the patients report improvement of their complaints (65.7%). The investigation provided evidence that stenosis of the trunk of the left coronary is a relatively frequent finding in the patient population with ischaemic heart disease and that it is most frequently associated with affection of two and three arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypoxic pulmonary hypertension: haemodynamic changes after oxygen and various vasodilators in the same patient at different time periods.

The haemodynamic response to oxygen breathing and various vasodilatory drugs (Nifedipine, Ketanserin, Dihydralazine, Nitroglycerin, Iso-Mack, Nit-Ret) was repeatedly measured at different time intervals (4-24 months) in 10 males with hypoxic pulmonary hypertension due to chronic obstructive lung disease. It was found that the pulmonary artery mean pressure and pulmonary vascular resistance changes are stable in most of the patients, discordant reactions being exceptional and of small degree. The authors consider these findings important in the therapeutical decision making for longterm oxygen therapy and or vasodilatory drug administration.

Body surface potential mapping (BSPM) before and after percutaneous transluminal coronary angioplasty (PTCA).

The departure index area of departure maps before and after the PTCA procedure was evaluated in 10 randomly chosen patients with clinically significant ischaemic heart disease. The body surface mapping system CARDIAG 128.1, (ZPA Prague-Cakovice) was used. The departure index was calculated using Kubota's formula. The departure indexes of the ST-T interval and departure maps of 36 ms and 80 ms intervals from the J point were followed. A decrease of the departure index area was considered as a sign of successful PTCA. A correct classification was made in 6 patients out of 9 (66%) with successfully performed PTCA. The identification of one patient with unsuccessful PTCA procedure was also correctly determined. The overall correlation between the effect of PTCA and the departure index area change was 7 out of 10 (70%). The authors consider this method to be a useful non-invasive method for identifying of successful or unsuccessful PTCA in patients with coronary artery disease.

[Late ventricular potentials--relation to the results of programmed ventricular stimulation, the incidence of ventricular ectopic arrhythmias and left ventricular function]. / Pozdní komorové potenciály--vztah k výsledku programované stimulace srdecních komor, k výskytu komorových ektopických arytmií a k funkci levé komory.

The authors evaluated the incidence of late ventricular potentials (LVP) in 84 patients (63 men and 21 women) with programmed stimulation of the ventricles. At the same time they described the relationship of the mentioned potentials to the finding of ventricular ectopic arrhythmias during ECG monitoring and left ventricular function (ultrasonographic examination). Non-invasive recording of late ventricular potentials is due to the assessed sensitivity, i.e. 73%, and specificity i.e. 67% (in relation to the results of programmed ventricular stimulation) a useful method for evaluation of the arrhythmogenic substrate of the heart muscle. The authors detected LVP in 35% of 37 subjects without arrhythmias, in 58% of 31 subjects with premature ventricular contractions class 3 to 5 according to Lown and in 60% of 15 subjects with relapsing ventricular tachycardias. LVP are more frequent in patients with impaired left ventricular function. They were recorded during the ejection fraction of the left ventricle beneath 50% in 69% of 16 subjects and in the left ventricular ejection fraction above 50% in 44% of 68 subjects.

[Predictive value of indicators of oxygen supply to tissues in patients with chronic obstructive lung disease]. / Predpovední význam ukazatelu dodávky kyslíku ke tkáním u nemocných s chronickou obstrukcní chorobou plicní.

The authors investigated in a group of 83 patients with chronic obstructive pulmonary disease the prognostic impact of some indicators of pulmonary function, haemodynamics and oxygen transport. They demonstrated that the prognosis is less favourable in patients with a lower one-second vital capacity with a higher median pressure in the pulmonary artery, with a lower oxygen tension in the arterial blood and higher haemoglobin concentration. They did not reveal significant differences between those who died and those who survived for more than five years, after the examination, as regards oxygen supply of tissues, oxygen consumption, coefficient of oxygen extraction and values of oxygen tension in mixed venous blood. Oxygen inhalation led to an increased oxygen supply of tissues and increased oxygen tension in mixed venous blood to normal values in all examined groups. This observation may be one of the explanations of the more favourable prognosis of patients with respiratory insufficiency, associated with chronic pulmonary obstructive disease, who have permanent oxygen therapy during domiciliary care.

Changes in pulmonary and systemic haemodynamics after the administration of various vasodilators in patients with pulmonary hypertension.

The authors investigated the influence of some vasodilatory drugs on pulmonary and systemic haemodynamic parameters in 69 patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (with the exception of two patients with diffuse pulmonary fibrosis and one patient with recurrent pulmonary thromboembolism). The investigated vasodilatory drugs were as follows: Dihydralazine Spofa--8 patients, Corinfar--10 patients, Ketanserin--13 patients, Nit-Ret 7 patients, Nitroglycerin Spofa--10 patients, Nitro-Mack--11 patients, Iso-Mack retard--10 patients. The haemodynamic parameters were measured before and at various time intervals after the administration of the vasodilatory agent (Dihydralazine 50 mg perorally--30th and 60th minute, Corinfar--20 mg sublingually--60th minute, and in 7 patients following a 6 months period of 30-60 mg Corinfar daily dose, Ketanserin--10 mg intravenously--10th, 20th and 40th minute, Nit-Ret--2.5 mg perorally--30th and 60th minute, Nitroglycerin Spofa--0.5 mg sublingually--10th and 30th minute, Nitro-Mack--1 mg intravenously--immediately following the end of a slow i. v. infusion for 20 minutes, Iso-Mack retard--20 mg perorally, 60th minute). The blood gases were measured at the same time intervals, too. The results in various groups were as follows: Dihydralazine administration was not followed by any significant change in PAP, CO, PVR, while a significant decrease in AOP and SVR was ascertained. A significant decrease of PaCO2 and no change in PaO2 were measured. Following Corinfar administration, no change in PAP, CO or PVR and a significant decrease of PaCO2 and no change in PaO2 were measured. Following Corinfar administration, no change in PAP, CO or PVR and a significant decrease in AOP were determined. No significant changes in blood gases were measured. Following a 6 month Corinfar treatment period in 7 subjects, no significant changes in pulmonary haemodynamics or blood gases values were found. No clinical benefit of this drug could be estimated. Ketanserin administration was not followed by any changes in pulmonary haemodynamics, whereas a significant decrease in AOP and SVR were found. The administration of Nit-Ret was followed by a significant decrease of CO, whereas no changes in PAP, AOP or PVR and SVR were found. No significant changes in the blood gas tenses values were measured. The administration of Nitroglycerin Spofa was followed by a significant decrease in RAP, PAP, AOP, RVEDP as well as in CO. No significant changes in blood gases were observed. The application of 1 mg Nitro-Mack intravenously was followed by a significant decrease in RAP, PAP, AOP and CO.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparative effects of oxygen, nifedipine and ketanserin in hypoxic pulmonary hypertension.

The authors measured changes in pulmonary and systemic haemodynamics in seven patients following oxygen inhalation, nifedipine and Ketanserin administration. A significant decrease in mean pulmonary artery pressure, cardiac index and heart rate could be observed following 30-min oxygen inhalation. No significant changes were found in pulmonary haemodynamics 1 hour after sublingual administration of 20 mg Corinfar (nifedipine). Long-term treatment (6 months) with Corinfar (30-60 mg per day) was not followed by a significant change in mean pulmonary artery pressure. However, in 3 patients a decrease in mean pulmonary artery pressure (6-11 mmHg) could be observed. Ketanserin (10 mg intravenously) did not significantly change the mean pulmonary artery pressure in patients with hypoxic pulmonary hypertension.