Does gender affect the outcomes of patients in program of managed care for acute myocardial infarction.

BACKGROUND: There is increasing evidence that cardiac rehabilitation and regular follow-ups are associated with reduced mortality and morbidity. A programme of Managed Care for Patients with Acute Myocardial Infarction was developed in Poland (MC-AMI; in Polish, KOS-zawal), based on current scientific evidence. However, there is a lack of data on possible improvement in long-term prognosis among women after acute myocardial infarction. AIMS: To compare the male and female population who participated in MC-AMI, regarding major cardiovascular events, defined as a composite of death, recurrent myocardial infarction, and hospital-ization for heart failure, in a 1-year follow-up. METHODS: A prospective research study from a single cardiology care centre. The study compared 2 groups: women and men who agreed to participate in the MC-AMI programme. RESULTS: A total of 529 patients were included in the study (167 women and 362 men). In the 12-month follow-up, the difference in major cardiovascular events events was not statistically significant for women and men, respectively (11.38% women vs 11.33% men; p = 0.98). Cox multivariate regression analysis of the surveyed population showed that coronary heart disease, diabetes mellitus type II, and previous percutaneous coronary intervention were significantly correlated with the primary endpoint. CONCLUSION: Women participating in the MC-AMI programme did not have a worse prognosis regarding major cardiovascular events, compared with men in a 12-month follow-up. Given the benefits of the MC-AMI programme, the proportion of women participating in the programme should be increased.

Differentiation of arrhythmia originating from the right or left ventricular outflow tract based on the QRS morphology of premature ventricular beats and duration of repolarisation.

BACKGROUND: Premature ventricular beats (PVBs) and monomorphic ventricular tachycardia originating from the right ventricular outflow tract (RVOT) are the most frequent forms of idiopathic ventricular arrhythmias, but arrhythmia originating from the left ventricular outflow tract (LVOT) may be found in about 10% of these patients. AIM: To compare electrocardiographic (ECG) patterns and duration of repolarisation after PVBs originating from the left and right superior part of the interventricular septum which were successfully treated with radiofrequency catheter ablation. METHODS: We studied 62 patients who did not receive antiarrhythmic drug treatment before ablation, including 50 patients with RVOT arrhythmia (21 males, mean age 42 ± 14 years, left ventricular ejection fraction [LVEF] 61 ± 6%) and 12 patients with LVOT arrhythmia (3 males, mean age 41 ± 17 years, LVEF 59 ± 9%). Pre-ablation 24-h Holter ECG recordings were analysed for the total number of PVBs. In addition, we evaluated ectopic beat QRS duration, prematurity index and duration of repolarisation (QT interval, JT interval and TpeakTend values uncorrected for the heart rate) based on ten random daytime PVBs during a period of stable sinus rhythm at a rate of 60-70 bpm. RESULTS: The study groups did not differ by age, LVEF, heart rate and the number of PVBs. RVOT arrhythmia was characterised by a lower prematurity index (0.59 ± 0.11 vs. 0.72 ± 0.09, p = 0.001) and a lower R/S ratio in leads V1-V3 (p < 0.01 for each lead). QRS duration of right-sided PVBs was shorter compared to that of left-sided PVBs (147 ± 13 vs. 166 ± 13 ms, p = 0.002), QT and JT intervals were similar (QT: 422 ± 32 vs. 429 ± 27 ms, p = 0.35; JT: 272 ± 27 vs. 266 ± 27 ms, p = 0.31), and TpeakTend was shorter in RVOT arrhythmia (100 ± 10 vs. 110 ± 6 ms, p = 0.01). Combination of R > S in lead V3 and TpeakTend-PVB > 110 ms identified LVOT arrhythmia with a sensitivity of 75% and specificity of 96%. CONCLUSIONS: Ventricular arrhythmias originating from the left or right superior part of the interventricular septum are not only characterised by different ECG patterns of ventricular ectopic beats but also show significant differences in the repolarisation phase.

Effect of postconditioning on infarction size, adverse left ventricular remodeling, and improvement in left ventricular systolic function in patients with first anterior ST­segment elevation myocardial infarction.

INTRODUCTION: A key method in the treatment of ST-elevation myocardial infarction (STEMI) is recanalization of the infarct-related artery, but this causes heart reperfusion injury. One of the methods to reduce this injury is postconditioning. The available data on the efficacy of this method are contradictory. OBJECTIVES: The aim of the study was to determine the safety of postconditioning as well as its effect on infarction size, improvement in left ventricular ejection fraction (LVEF), and adverse LV remodeling during a 3-month follow-up. PATIENTS AND METHODS: The study involved 39 patients with first anterior STEMI (aged 58 ± 10 years) up to 12 hours from the onset of symptoms. They were randomly assigned to a traditional-reperfusion group (n = 21) or to a postconditioning group (n = 18). The area at risk (AAR) was assessed angiographically. LV remodeling and LVEF were evaluated using echocardiography at 6 days and at 3 months. The infarction size was defined on the basis of magnetic resonance imaging (MRI) at 3 months. RESULTS: In a univariate logistic regression analysis, postconditioning did not affect the improvement of LVEF (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.34-7.7; P = 0.52) or the development of adverse LV remodeling (OR, 0.62; 95% CI, 0.15-2.53; P = 0.5). Moreover, there were no significant differences in infarction size between the groups as measured by MRI after adjustment for the AAR, time to reperfusion, and ST-segment elevation prior to percutaneous coronary intervention. CONCLUSIONS: Postconditioning is a safe method but its application did not affect the volume of the infarction as well as did not improve LVEF or the development of adverse LV remodeling in a 3-month follow-up.

Prediction of infarct size by speckle tracking echocardiography in patients with anterior myocardial infarction.

BACKGROUND: Speckle tracking echocardiography (STE) is based on tracing of pixel groups in grayness scale for the quantitative measurement of myocardium strain and myocardium strain rate. Recent data suggest that evaluation of STE could be a tool for myocardial function assessment similar to MRI. AIM: To assess the predictive value of STE for the evaluation of infarct size in patients with anterior ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 39 patients with the first anterior wall STEMI (mean age 59±10 years, 29 men). All patients were treated with a primary percutaneous coronary intervention, and the time from the symptom onset to reperfusion was 298±195 min. Left ventricular ejection fraction assessed in three-dimensional echocardiography was 47±9%. On the day of discharge, STE was performed to determine the average global value of peak longitudinal strain (GLS) of 16 myocardial segments. The average value of the peak longitudinal strain for nine segments supplied by the left anterior descending artery anterior wall global longitudinal strain was assessed separately. Infarct size was assessed 3 months after STEMI by MRI using late gadolinium enhancement, and a large infarct was defined as at least 20% left ventricle myocardium covered by the scar. RESULTS: According to the results of MRI, we defined two groups: 22 patients with a large infarct (≥20%, group A) and 17 patients with a small infarct (<20%, group B). There were no differences between both groups in the demographics and cardiovascular risk factors. There was a significant correlation between GLS and the degree of myocardium injury assessed by MRI (r=0.62, P=0.001). The correlation was higher for anterior wall global longitudinal strain (r=0.68, P=0.001). With the receiver operating characteristic curve, the cut-off point for GLS was calculated (-12.3), which defined a large infarct with 82% sensitivity and 87% specificity (area under the curve=83). For segments supplied by the left anterior descending artery, the cut-off value for the prediction of a large infarct was -11.5 (sensitivity 90%, specificity 73%, area under the curve=84). CONCLUSION: STE seems to be a very promising tool in the prediction of infarct size in patients with anterior STEMI.