Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with different therapeutic strategies. Results from WIelkopolska REgional 2002 Registry (WIRE Registry).

BACKGROUND: Although primary coronary angioplasty seems to be the best treatment in acute myocardial infarction (MI), thrombolytic therapy still remains the most common reperfusion strategy particularly in smaller centers. Nowadays, different regional networks are developed to improve the treatment of patients with MI. AIM: To analyse the effects of different therapeutic strategies on 30-day and long-term mortality (median time 18.3 months) after ST-elevation MI (STEMI) in a population of 3 350 000 people from the Wielkopolska Region. METHODS: In 2002, 3780 patients with STEMI entered the registry. Complete data were available for 3564 (94.3%) patients. Depending on therapeutic strategies, patients were divided into five groups: the PCI group--direct percutaneous coronary angioplasty (PCI) in small cathlab, 'selected patients', n=381 (10.7%); the PA group--aged <70, treated with tissue plasminogen activator (rt-PA) up to 4 hours from the onset of chest pain, n=479 (13.4%); the IS group - invasive strategy in every patient, 24-hour duty, setting of unselected patients with STEMI, n=989 (27.7%); the SK group--patients receiving standard streptokinase treatment up to 12 hours from the onset of chest pain, n=584 (16.4%); the NR group--no reperfusion therapy, n=1131 (31.7%). RESULTS: The 30-day mortality rate in the groups above was: 3.15, 4.38, 4.54, 9.25, and 12.5% respectively (p <0.001). Long-term mortality rate was: 4.2, 9.4, 9.4, 14.4, and 18.50% respectively (p <0.001). The rate of urgent PCI in the PA group was 25% and in the SK group--11% (p <0.001). CONCLUSIONS: Treatment with rt-PA in patients under 70 years of age and up to 4 hours from pain onset may be an alternative to an invasive strategy. However, a quarter of those patients require urgent PCI. In long-term observation the mortality benefit can be clearly seen only in patients with early PCI.

Prolonged QRS duration in patients with heart failure: relation to exercise tolerance, diastolic function and aetiology.

BACKGROUND: In patients with chronic heart failure (CHF) QRS prolongation is a frequent finding and is related to increased morbidity and mortality. It is not clear if prolonged QRS in CHF of ischaemic origin (CAD) represents the same severity of the syndrome as in non-ischaemic (non-CAD) cardiomyopathy. AIM: To assess the relationship between QRS duration and BNP levels, diastolic function and peak VO2 in patients with CAD CHF and non-CAD CHF. METHODS: In 70 patients with left ventricular ejection fraction (LVEF) <45% [35 with left bundle branch block (LBBB)] echocardiography, cardiopulmonary exercise test and standard ECG were performed as well as BNP level was measured. RESULTS: Peak VO2 was significantly lower, BNP level higher in patients with LBBB than those without LBBB. In the non-CAD CHF peak VO2 was significantly lower, whereas BNP levels and restrictive filling pattern prevalence higher in the group with LBBB than without LBBB, which was not seen in the CAD CHF group. A significant correlation between peak VO2 and BNP levels (r=-0.31; p=0.02), QRS duration (r=-0.27; p=0.02), and diastolic function parameter - DTE (r=0.28; p=0.02) was found. Peak VO2 was significantly lower in the CAD CHF than in non-CAD CHF. In multivariate regression analysis, LVEF (r=-0.32; p=0.012) and LVEDD (r=0.30; p=0.015) were independently associated with QRS duration. CONCLUSION: In patients with CHF, QRS duration is independently related to LVEF and LVEDD. It seems that prolonged QRS may be a better predictor of more advanced CHF in patients with non-ischaemic rather than ischaemic cardiomyopathy.

First heart sound and opening snap in patients with mitral valve disease. Phonocardiographic and pathomorphologic study.

We investigated correlation between mitral valve morphology and first heart sound (S(1)) and opening snap (OS) amplitude. The analysis revealed negative correlation between the OS amplitude and the area of calcification and the mitral orifice area. We also found negative correlation between the S(1) intensity and the area of calcification.

Mortality in patients with heart failure treated with cardiac resynchronisation therapy. A long-term multi-centre follow-up study.

BACKGROUND: Benefits of cardiac resynchronisation therapy (CRT) for survival in selected congestive heart failure (CHF) patients have been acknowledged by the 2005 ESC guidelines. AIM: To analyse mortality in CRT pacing only (CRT-P) patients during at least one-year follow-up. METHODS: This was a prospective, multi-site, at least one-year observational study on mortality and mode of death in patients who received CRT-P due to commonly accepted indications. One-year follow-up data (or earlier death) were available for 105 patients (19 females, 86 males) aged 60.6+/-9.8 years (35-78). Baseline NYHA class was 3.2+/-0.4 (3-4). Coronary artery disease (CAD) was the underlying aetiology of CHF in 57 (54%) patients and 48 (46%) patients had CHF due to non-coronary factors. RESULTS: Mean follow-up duration was 730 days (360-1780), median 625. There were 21 (20%) deaths: 5 (24%) sudden cardiac deaths (SCD), 13 (62%) deaths due to heart failure (HFD) and 3 (14%) other deaths. Thirteen (62%) patients died within the first year of observation. All SCD occurred in this period. Mean time to death was 303+/-277 days (19-960) to HFD - 339+/-313 days (19-960) and to SCD - 208+/-127 days (31-343). There were no significant differences between survivors and non-survivors with respect to left ventricular ejection fraction (LVEF) (25+/-10 vs. 20+/-8%), 6-minute walk test (6 min WT) (276+/-166 vs. 285+/-163 m) and LV diastolic diameter (LVEDD) (71+/-9 vs. 78+/-10 mm) (all NS). The SCD and HFD patients had similar age (62.0+/-5.4 vs. 56.6+/-13.2 years), gender (80 vs. 83% males), NYHA class (3.1+/-0.2 vs. 3.5+/-0.3), LVEF (22+/-9 vs. 17+/-5%), LVEDD (86+/-10 vs. 79+/-9 mm), 6 min WT (270+/-142 vs. 292+/-188 m) (NS). In 4 patients from the SCD group CHF was of non-coronary aetiology and only in 1 patient from the HFD group (p=0.003). The values of LVEF, LVEDD and NYHA class in HFD patients who died during the first year after implantation, compared with those who died later, were similar. CONCLUSIONS: Sudden cardiac death probability in the studied CRT-P population was the highest during the first year after implantation. Afterwards, the risk of HFD started to increase. Thus, in all patients eligible for CRT prophylactic defibrillation function should be considered.

Restrictive filling pattern predicts pulmonary hypertension and is associated with increased BNP levels and impaired exercise capacity in patients with heart failure.

BACKGROUND: Left ventricular (LV) diastolic dysfunction is a common finding in patients with systolic heart failure (HF). Severe diastolic dysfunction, which is defined as LV restrictive filling pattern (RFP), is associated with more severe HF, increased sympathetic activity and reduced exercise capacity. It has also been shown to be a predictor of lower survival rate in patients with HF. AIM: To evaluate associations between LV diastolic RFP and BNP levels, systolic pulmonary pressure and exercise capacity in patients with clinically stable HF. METHODS: In 56 patients with HF and low LVEF a standard echocardiographic study and cardiopulmonary exercise test were performed. Levels of BNP using RIA method were also measured. RESULTS: Restrictive filling pattern (E/A >2 or 1< E/A <2 and DTE < or =130 ms) was diagnosed in 26 patients. The RFP group showed increased levels of BNP (90.6+/-66 vs. 50.4+/-61 pg/ml; p=0.003), significantly reduced peak VO2 (15.4+/-4.1 vs. 17.8+/-4.9 ml/kg/min; p=0.046), increased VE/VCO2 slope (36.3+/-5.9 vs. 31.9+/-6.3; p=0.01), and elevated PASP (pulmonary artery systolic pressure measured by echo-Doppler) (49.3+/-13.8 vs. 37.2+/-12.6 mmHg; p=0.02). Prevalence of pulmonary hypertension was significantly higher in the RFP group. A significant correlation between DTE and peak VO2 (r=0.28; p=0.02) and inverse correlations between DTE and BNP levels (r=-048; p=0.003), VE/VCO2 slope (r=-0.35; p=0.02) and PASP (r=-0.39; p=0.03) were found. In logistic regression analysis only RFP was independently associated with pulmonary hypertension. CONCLUSIONS: The restrictive filling pattern is an independent predictor of pulmonary hypertension and is associated with increased BNP levels and worse result of cardiopulmonary exercise test.

[Twiddler syndrome: a rare complication of ICD implantation]. / Twiddler syndrome - rzadkie powiklanie wszczepienia kardiowertera-defibrylatora.

Twiddler syndrome is a rare complication after pacemaker or ICD implantation. We present a case of a man who experienced 7 inappropriate ICD shocks because of this complication. Treatment included total system removal and new device implantation on the right side.

Polish Registry of Acute Coronary Syndromes (PL-ACS). Characteristics, treatments and outcomes of patients with acute coronary syndromes in Poland.

BACKGROUND: In Poland, together with the transformation of the political system, significant positive changes have been made to the national health care system. This provided a possibility for hospitals to apply current standards of care to patients with acute coronary syndromes (ACS). AIM: To assess contemporary data on epidemiology, management and outcomes of patients with ACS in Poland, and to evaluate adherence to the guidelines' recommended treatment. METHODS: We performed an observational study of 100,193 patients hospitalised due to unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI), prospectively enrolled in 417 hospitals from October 2003 to March 2006 in the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS). The registry is carried out in cooperation with the Ministry of Health and the National Health Fund. RESULTS: The initial diagnoses were unstable angina in 42.2%, NSTEMI in 26.6%, and STEMI in 31.2% of patients. About one-third of patients were treated outside of cardiology departments (mainly in the internal medicine wards). In patients without ST elevation, invasive strategy (early coronary angiography) was used with almost equal frequency in unstable angina (29.4%) and NSTEMI (31.7%). However, in-hospital mortality was low in unstable angina (0.8%), being much higher in NSTEMI patients (6.6%), (p<0.001). In STEMI reperfusion therapy was administered in 63.3% of patients (thrombolysis 7.8%, primary PCI 54.1%, and PCI after thrombolysis 1.4%). In-hospital mortality in STEMI was 9.3%. Median times from the onset of symptoms to invasive treatment were: 37 hours in unstable angina, 23 hours in NSTEMI, and 5 hours in STEMI. The guidelines' recommended pharmacotherapy was used in a high percentage of patients except for thienopyridines and GP IIb/IIIa inhibitors. CONCLUSIONS: The Polish Registry of Acute Coronary Syndromes shows several discrepancies between guidelines' recommended treatment and their utilisation in everyday practice. Particularly, the under-utilisation of invasive treatment in patients with NSTEMI is alarming. Efforts should be made to increase the usage of invasive treatment in NSTEMI patients and to shorten the delay from the symptom onset to intervention.

Impaired glucose tolerance worsens exercise capacity and ventilatory response to exercise in patients with chronic heart failure.

BACKGROUND: There is increasing evidence for the importance of peripheral abnormalities in the pathogenesis and progression of heart failure (HF). Recently, glucose and insulin metabolism abnormalities have been intensively investigated in patients with HF. AIM: To investigate whether coexistence of impaired glucose tolerance (IGT) may decrease exercise tolerance and influence ventilatory response to exercise in patients with systolic HF. METHODS: Maximal cardiopulmonary exercise test with evaluation of peak VO2 and VE/VCO2 slope and oral glucose tolerance test were performed in 64 clinically stable patients with HF and LVEF <45%. RESULTS: Impaired glucose tolerance was diagnosed in 26 (41%) patients and normal glucose tolerance (NGT) in 38 (59%) patients. There were no significant differences in baseline clinical characteristics or LVEF between groups. There were significant differences in peak VO2 between IGT and NGT (15.4+/-4.1 vs. 18.7+/-4.2 ml/kg/min respectively; p=0.003) and VE/VCO2 slope (35.7+/-7.3 vs. 31.8+/-5.7 respectively; p=0.02). The IGT was independently related to peak VO2 and VE/VCO2 slope in multivariate regression analysis. CONCLUSION: The IGT is associated with worse exercise capacity and ventilatory response to exercise in patients with HF.

[Presyncope caused by non-sustained ventricular tachycardia. Significance of RF ablation]. / Omdlenia z powodu krótkotrwalych napadów czestoskurczu komorowego. Rola ablacji RF.

We describe a case of a 55-year-old man with episodes of presyncope caused by non-sustained ventricular tachycardia (ns-VT). Symptoms of significant weakness started when he was 30-year-old. In the last 2 years there was a substantial increase in frequency of presyncope from 2 per month to 8 per week. He does not have palpitations. Standard ECG, echocardiography and coronary angiography were normal. During an exercise test ns-VT 220/min (5 s, 20 x QRS) with LBBB morphology was documented. Successful RF ablation of ns-VT using the CARTO system was performed. During 4-month follow-up the patient remains free from ventricular arrhythmia.

Acute myocardial infarction and rapid development of coronary aneurysms in a young woman--unusual presentation of Takayasu arteritis?

The present report describes a young female patient with acute myocardial infarction and inflammatory lesions limited to proximal and midsegments of the left anterior descending coronary artery. Based on the presence of positive inflammatory markers, an angiographically confirmed coronary artery lesion and the young age of the patient, an atypical presentation of Takayasu arteritis was diagnosed.

Effect of microvascular reperfusion on prognosis and left ventricular function in anterior wall myocardial infarction treated with primary angioplasty.

BACKGROUND: Myocardial reperfusion in acute myocardial infarction may fail despite successful recanalization of the infarct-related artery. The purpose of this study was to assess the impact of myocardial reperfusion on clinical outcome and left ventricular (LV) function. METHODS: The clinical significance of myocardial blush grade (MBG)-angiographic marker of myocardial reperfusion, in 104 patients (age 62+/-13 years) with first anterior myocardial infarction, successfully (TIMI 3) treated with primary angioplasty was analysed. Echocardiography was performed at baseline and after 6 months. Mortality and major cardiovascular event (MACE) rates were analysed 30 days and 1 year after acute myocardial infarction. Patients were divided into two groups according to presence (group 1, MBG 2-3, n=64) or absence of myocardial blush (group 2, MBG 0-1, n=40). RESULTS: One-year mortality was significantly higher in group 2 in comparison to group 1 (22.5% vs 6.25%, HR: 3.6, 95% CI: 1.187-10.9, p=0.0175). The rate of MACE was significantly lower in patients with MBG 2-3, both after 1 and 12 months (9.4% vs 30%, p=0.008 and 20.3% vs 60%, p<0.001, respectively). At baseline, both global and regional contractile function were significantly better in group 1 than in group 2 (ejection fraction (EF) 47.4+/-8.8% vs 43.3+/-7.9%, p=0.04 and wall motion score index (WMSI) 1.64+/-0.4 vs 1.87+/-0.3, p=0.001, respectively). Similarly, at 6 months follow-up, LV function was better in group 1 as compared with group 2 (EF 54.9+/-14.5% vs 46+/-13.2%, p=0.005 and WMSI 1.43+/-0.4 vs 1.76+/-0.46, p=0.001, respectively). CONCLUSIONS: Impaired microvascular reperfusion in patients with anterior myocardial infarction is associated with poor prognosis and worse early and late left ventricular function.

Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial.

BACKGROUND: In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. OBJECTIVES: The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. METHODS: The 15,245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. RESULTS: For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P = 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. CONCLUSION: As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipine-based treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women.

Effect of heparin on blood vascular endothelial growth factor levels in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

It has been demonstrated that high blood vascular endothelial growth factor (VEGF) levels in patients with myocardial infarction decrease rapidly after reperfusion, possibly in response to heparin administration. We measured serum VEGF concentration before and after heparin infusion in 105 patients with ST-elevation acute myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Serum VEGF concentration in patients with STEMI was significantly higher than in healthy controls. After PCI, the concentration of VEGF decreased by approximately 70%, with the greatest decrease seen in patients with the highest initial VEGF levels. To determine whether heparin could decrease VEGF concentration by sequestering VEGF in the endothelium, a fixed dose of recombinant VEGF was incubated for 40 minutes with EA.hy926 endothelial cells in vitro. Recovery of VEGF from medium after culture was decreased by up to 15% with increasing doses of heparin. Concentration of VEGF did not change in the absence of heparin and/or endothelial cells. In conclusion, these results suggest that a rapid decrease in blood VEGF after PCI may be related to the administration of heparin, which binds simultaneously to VEGF and endothelial cells.

Effect of impaired myocardial reperfusion on left ventricular remodeling in patients with anterior wall acute myocardial infarction treated with primary coronary intervention.

We assessed the effect of impaired myocardial blush after primary coronary intervention (PCI) on left ventricular remodeling in patients with ST-segment elevation myocardial infarction (STEMI). The study population consisted of 145 patients with first anterior STEMI that was treated successfully (Thrombolysis In Myocardial Infarction grade 3 flow) with PCI. Left ventricular remodeling was defined as an increase of > or =20% in end-diastolic volume based on repeated echocardiographic measurements in patients. The study population was divided into 2 groups according to the presence (myocardial blush grade [MBG] 2 to 3, n = 86) or absence (MBG 0 to 1, n = 59) of myocardial reperfusion. Left ventricular remodeling appeared in 21% of the entire study group. Poor myocardial blush after PCI was associated with an increased rate of remodeling compared with good myocardial reperfusion (32% vs 14%, hazard ratio 2.308, 95% confidence interval [CI] 1.21 to 4.39, p=0.014). Symptoms of heart failure were observed significantly more often in patients with MBG 0 to 1 (35.6% vs 18.6%, p = 0.032) than in patients with MBG 2 to 3. In multivariate analysis, only age (odds ratio 0.96, 95% CI 0.92 to 0.99, p = 0.02) and MBG 0 to 1 (odds ratio 3.15, 95% CI 1.35 to 7.31, p = 0.008) were associated with left ventricular dilation. In conclusion, impaired microvascular reperfusion is associated with left ventricular remodeling and development of congestive heart failure in patients with anterior STEMI that is treated with primary coronary angioplasty.

[The risk of mitral pathology in marphanoid female basketball players]. / Ryzyko wystepowania patologii zastawki mitralnej u dziewczat o marfanoidalnym fenotypie uprawiajacych wyczynowo koszykówke.

UNLABELLED: Recently much research has been done focusing on the problem of athlete's heart as a physiological phenomenon as well as a cause of morbidity or even mortality. The question rises whether pathology discovered in some athletes was primary or developed after professional excessive training program. THE AIM: We studied a group of young female athletes (basketball players) to test the hypothesis that marfanoid habitus, favorable in this sport, could bear predisposition for pathology of the heart. MATERIAL AND METHODS: We studied 38 young female athletes, mean age 15 (+/- 1.8) years, participants of special education program for talented sportsmen from all over Poland. Athletes were included on the basis of outstanding results and participating at least one year in professional basketball. Complete echocardiographic examination was performed according to protocol which included M-mode, 2D and color Doppler. Systolic and diastolic morphologic and functional parameters were assessed and compared to normal values related to the age. RESULTS: Stature of studied athletes exceeded the 95 percentile. There were no significant differences in morphological parameters of the heart. Mitral incompetence (at least II grade) was a common finding in this group (37%). In the group exhibiting marphanoid habitus, mitral incompetence was present in all except one case (89%). CONCLUSIONS: Tall stature being favorable in basketball promotes athletes with marphanoid habitus which have higher risk of mitral incompetence.

[Acute myocardial infarction complicated by cardiogenic shock. Difficult decision concerning long-distance transportation to a tertiary centre -- a case report]. / Zawal serca ze wstrzasem. Trudna decyzja o transporcie do osrodka referencyjnego.

A case of a 60-year-old female with acute myocardial infarction complicated by cardiogenic shock is presented. The patient received thrombolytic therapy, however, developed cardiogenic shock and required resuscitation with intubation, mechanical ventilation and repeated defibrillation due to recurrent ventricular fibrillation. The patient was transported by air to the tertiary centre with catheterisation laboratory (distance -- 120 km), where successful angioplasty with stent implantation in the right coronary artery was performed. Difficulties in transportation of patients with fully-developed cardiogenic shock are discussed.

Relationship between tissue reperfusion and postinfarction left ventricular remodelling in patients with anterior wall myocardial infarction treated with primary coronary angioplasty.

INTRODUCTION: Pathological left ventricular remodelling is considered the main cause of heart failure in patients after myocardial infarction. AIM: The purpose of this study was to evaluate correlations between the degree of coronary microvascular reperfusion assessed by means of the angiographic myocardial blush grade (MBG) scale and adverse left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary angioplasty. METHODS: This study involved 92 consecutive patients, hospitalised because of their first anterior wall myocardial infarction, who underwent successful (TIMI-3 grade flow) primary coronary angioplasty. Angiographic myocardial reperfusion parameters (MBG, corrected TIMI Frame Count) were assessed. Three days and 6 months after the index PCI all patients underwent an echocardiographic examination and such parameters as end-diastolic volume (EDV), left ventricular ejection fraction (EF) and contractility index (WMSI) were calculated. RESULTS: The patients were divided into two groups: group 1 with impaired myocardial reperfusion (MBG 0-1) (n=32) and group 2 with adequate tissue reperfusion (MBG 2-3) (n=60). Negative left ventricular remodelling was observed more frequently in group 1 than in group 2 (28.1% vs 10%, p=0.029). More patients in group 1 presented heart failure symptoms (56.3% vs 25%, p=0.013). CONCLUSIONS: Failure of tissue reperfusion assessed by means of angiographic indices (MBG 0-1) in patients with myocardial infarction treated with primary coronary angioplasty is associated with a higher rate of adverse myocardial remodelling and heart failure at 6 months after myocardial infarction.

Evaluation of exercise capacity with cardiopulmonary exercise testing and type B natriuretic peptide concentrations in adult patients with patent atrial septal defect.

UNLABELLED: Adults with patent atrial septal defect (ASD) usually find their exercise capacity satisfactory, and therefore hesitate to accept proposed surgical treatment of the heart disease. The aim of our study was to evaluate both the exercise capacity, using the cardio-pulmonary stress test, and brain natriuretic peptide (BNP) levels in asymptomatic adults with ASD. Thirty-six patients with patent secundum type ASD (aged mean 44.7 +/- 8.2 years) were studied. The control group consisted of 25 healthy subjects at the mean age of 45.6 +/- 6.1 years. Echocardiography and CPST were performed and BNP levels measured in all subjects. Oxygen uptake (VO2 max) was lower in ASD patients than in controls (22.1 +/- 5.6 vs. 30.0 +/- 6.8 ml/kg/min, p = 0.00001); the VE/VO2 slope was elevated in ASD patients compared with healthy subjects (31.3 +/- 6.6 vs. 26.9 +/- 3.3, p = 0.001), and exceeded 34 in 5 patients. VO2 max showed a negative correlation with the pulmonary to systemic flow ratio Qp:Qs (r = -0.46, p = 0.004), and a positive correlation was found between the VE/VO2 slope and Qp:Qs (r = 0.32, p = 0.05). BNP levels were higher in the ASD group than in the controls (60.6 +/- 49.9 vs. 32.6 +/- 24.5 pg/ml, p = 0.02). BNP correlated positively with RV diameter and Qp:Qs (r = 0.38 and 0.39 respectively, p = 0.03) and negatively with maximum VO2 (r = -0.5, p = 0.004) and VO2% (r = -0.32, p = 0.07). CONCLUSIONS: Although most adult patients with ASD perceive their exercise capacity as satisfactory, objective assessment reveals that in fact it is significantly decreased. BNP levels are increased comparing to healthy individuals. Decreased exercise capacity and increased BNP levels seem to result from right ventricular volume overload.

Chronic infarct-related artery occlusion is associated with a reduction in capillary density. Effects on infarct healing.

AIM: To assess the relationship between infarct-related artery (IRA) stenosis and capillary density and to assess its effect on scar formation in the human heart. MATERIALS AND METHODS: Morphometric evaluation was performed in 51 human hearts, as follows. Group I non-cardiac death (control), Group II post-Q-wave myocardial infarction (QMI) death and Group III patients who survived QMI and who underwent aneurysmectomy. Using morphometric parameters, the relationship between left ventricle (LV) mass, infarct size, IRA stenosis, cellular hypertrophy and changes in microcirculation were analyzed within the infarcted area and free LV wall. RESULTS: A significant reduction in capillary density within the infarcted area was noted in group II when compared to the control group (1525.6+/-378.5/mm(2) vs. 2968.7+/-457.3/mm(2); p<0.001). Reduction in capillary density was inversely related to infarct size (r=-0.616; p=0.006) and degree of IRA stenosis (r(S)=-0.512; p=0.03). The most significant reduction in capillary density was observed in patients with total IRA occlusion (1204.6+/-156.9/mm(2) vs. 1676.6+/-245.8/mm(2); p<0.001). Similarly, a reduction in capillary density of over 60% (1030.7+/-241.8/mm(2)) was observed within aneurysms resected surgically. CONCLUSIONS: The study demonstrated precise quantification of the capillary network in patients following QMI. The most significant reduction in capillary density was observed in patients with chronic total IRA occlusion.