Does HAS-BLED risk score underestimate the risk of bleeding in patients with triple antithrombotic therapy?

stroke or other thromboembolic complications in patients with atrial fibrillation (AF). On the other hand, dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) represents a cornerstone in the treatment of acute coronary syndrome. Atrial fibrillation is relatively common in patients with coronary artery disease and patients who undergo primary percutaneous coronary interventions (PCI) with stent implantation. They should be on triple antithrombotic therapy (TAT): preferably direct oral anticoagulants (DOAC) plus aspirin plus clopidogrel as it prevents ischemic as well as thromboembolic events. Before introducing OAT in patients with AF we must assess the risk of future bleeding episodes as OAT can lead to some life-threatening bleeding events. The most common risk score used for that purpose is HASBLED score. HAS-BLED score is valuable, proven tool in assessing future bleeding events in patients with AF. Nevertheless, it does not make the difference between dual and triple antithrombotic therapy which can be of great importance in preventing bleeding events.

Detrimental effects of a bout of physical exercise on circulating endogenous inhibitors of endothelial function in patients with coronary artery disease.

BACKGROUND: A bout of intense physical activity has been shown to transiently impair endothelial function; however, the underlying mechanisms are unclear. AIM: The purpose of the review was to assess the impact of a bout of physical exercise induced by exercise stress echocardiography, on blood concentration of the endogenous inhibitors of nitric oxide synthase, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA), in patients with atherosclerosis. METHODS: Overall, 83 study participants were enrolled, 25 coronary artery disease (CAD) patients, 20 age and sex-matched asymptomatic study participants with at least one risk factor for CAD, and 38 healthy controls. RESULTS: Patients with CAD developed symptoms and/or left ventricular wall motion abnormalities during exercise; no changes were seen in study participants with risk factors, or in healthy controls. At baseline, in CAD patients and in study participants with risk factors, both ADMA and SDMA were higher than healthy controls (P < 0.001). However, a further large increase occurred during exercise stress echocardiography in both groups, regardless of development of symptoms (P < 0.001). CONCLUSION: Basal concentrations of ADMA and SDMA are high in CAD patients and in study participants with risk factors, consistent with impaired nitric oxide synthase activity in atherosclerosis. Large increase of these endogenous inhibitors of nitric oxide during intense exercise provide support to the hypothesis that in patients with atherosclerosis endothelial function may further deteriorate as a consequence of a bout of physical activity.

The influence of type 2 diabetes mellitus on the frequency and complexity of ventricular arrhythmias and heart rate variability in patients after myocardial infarction.

Background/Aim: After myocardial infarction arrhythmic cardiac deaths are significantly more frequent compared to non-arrhythmic ones. The aim of the study was to investigate the influence of type 2 diabetes mellitus (T2DM) on the frequency and complexity of ventricular arrhythmias after myocardial infarction. Methods: The study included 293 patients, mean age 59.5 ± 9.21 years, who were at least six months after acute myocardial infarction with the sinus rhythm, without atrioventricular blocks and branch blocks. In the clinical group 95 (32.42%) patients were with T2DM, while 198 (67.57%) patients were without diabetes. All of the patients were subjected to the following procedures: standard ECG according to which the corrected QT dispersion (QTdc) was calculated, exercise stress test, and 24-hour holter monitoring according to which, the four parameters of time domain of heart rate variability (HRV) were analyzed: standard deviation of all normal RR intervals during 24 hours (SDNN), standard deviation of the averages of normal RR intervals in all five-minute segments during 24 hours (SDANN), the square root of the mean of the sum of the squares of differences between adjacent normal (RMS-SD), and percentage of consequtive RR intervals which differed for more than 50 ms during 24 hours (NN > 50 ms). Results: In patients after myocardial infarction, patients with T2DM had significantly higher percentage of frequent and complex ventricular arrhythmias compared to the patients without diabetes (p < 0.001). The patients with T2DM had significantly higher percentage of residual ischemia (p < 0.001), and arterial hypertension (p < 0.001), compared to patients without diabetes. The patients with T2DM had significantly lower values of HRV parameters: SDNN (p < 0.001); SDANN (p < 0.001); RMS-SD (p < 0.001), and NN > 50 ms (p < 0.001), and significantly higher values of QTdc (p < 0.001) compared to the patients without diabetes. Conclusion: The study showed that type 2 diabetes mellitus has significant influence on ventricular arrhythmias, HRV parameters and QT dispersion in patients after myocardial infarction.

The significance of adiponectin as a biomarker in metabolic syndrome and/or coronary artery disease.

UNLABELLED: BACKGROUND/AIM. Adiponectin exerts profound protective actions during insulin resistence or prediabetes progression towards more severe clinical entities such as metabolic syndrome and/or cardiovascular disease. Since hypoadiponectinaemia contributes to the pathophysiology of the metabolic syndrome and coronary artery disease the level of circulating adiponectin may be an early marker of cardiovascular events. The aim of this study was to determine the relationships between serum adiponectin levels and parameters of both insulin sensitivity and obesity in patients with the metabolic syndrome and/or coronary artery disease, as well as to assess predictive value of adiponectin serum levels as a biomarker of these entitetis. METHODS: The study included 100 patients with metabolic syndrome and/or coronary artery disease with different degree of insulin resistance and healthy, normoglycemic individuals. The control group comprising healthy, normoglycemic individuals was used for comparison. Serum level of adiponectin, fasting glucose, fasting insulinemia Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index and anthropometric parameters were determined in all the subjects. Adiponectin was measured by using the ultrasensitive ELISA method. Insulinemia was measured by the radioimmunoassay (RIA) method. The presence of glycemic disorders was assessed on the basis of oral glucose tolerance test (OGTT). Results. Adiponectin level was inversely correlated with age (ρ = -0.015), parameters of both obesity (R = 0.437;p < 0.001) and insulin resistance (R = 0.374; p < 0.01). Decreasing in the level of adiponecrin was strongly implicated in the development of insulin resistance. Most importantly, a statistically significant rapid decrease ih adiponectin was in the prediabetic stages (p < 0.01). The predictor value of adiponectin was 1,356.32 ± 402.65 pg/mL. CONCLUSIONS: The obtained resultats suggest that adiponectin may be a useful marker in identification of individuals with risk of developing metabolic syndrome and coronary artery disease, as well as a predictor of prediabetes.

Circulating purine compounds, uric acid, and xanthine oxidase/dehydrogenase relationship in essential hypertension and end stage renal disease.

Purine nucleotide liberation and their metabolic rate of interconversion may be important in the development of hypertension and its renal consequences. In the present study, blood triphosphate (ATP), adenosine diphosphate (ADP), and adenosine monophosphate (AMP) breakdown pathway was evaluated in relation to uric acid concentration and xanthine dehydrogenase/xanthine oxidase (XDH/XO) in patients with essential hypertension, patients with chronic renal diseases on dialysis, and control individuals. The pattern of nucleotide catabolism was significantly shifted toward catabolic compounds, including ADP, AMP, and uric acid in patients on dialysis program. A significant fall of ATP was more expressed in a group of patients on dialysis program, compared with the control value (p<0.001), while ADP and AMP were significantly increased in both groups of patients compared with control healthy individuals (p<0.001), together with their final degradation product, uric acid (p<0.001). The index of ATP/ADP and ATP/uric acid showed gradual significant fall in both the groups, compared with the control value (p<0.001), near five times in a group on dialysis. Total XOD was up-regulated significantly in a group with essential hypertension, more than in a group on dialysis. The activity of XO, which dominantly contributes reactive oxygen species (ROS) production, significantly increased in dialysis group, more than in a group with essential hypertension. In conclusion, the examination of the role of circulating purine nucleotides and uric acid in pathogenesis of hypertension and possible development of renal disease, together with XO role in ROS production, may help in modulating their liberation and ROS production in slowing progression from hypertension to renal failure.

Blood pressure variability and left ventricular mass index in children.

Clinical implications of blood pressure variability (BPV) on subclinical organ damage in children are unknown. The authors sought to explore the potential utility of two newly derived BPV indices: weighted standard deviation (wBPSD) and real average variability (ARV), as well as two standard ambulatory blood pressure indices: average 24-hour systolic blood pressure (SBP) and 24-hour SBP load, to identify children at high risk for left ventricular (LV) hypertrophy (LVH). The study group consisted of 67 consecutive children who were referred to our institution for evaluation of suspected hypertension. LV mass was estimated by M-mode echocardiography using Devereux's formula according to the Penn convention and indexed for height(2.7) . We found a statistically significant, positive correlation between 24-hour wBPSD and LV mass index (LVMI) (ρ=0.389; P=.002) and no correlation between 24-hour ARV and LVMI (P>.05). However, partial correlation analysis of 24-hour wBPSD adjusted for body mass index (BMI) and LVMI showed only a weak correlation (ρ=0.3; P=.022). By using multiple linear regression analysis in a model with LVMI as a dependent variable and 24-hour wBPSD, 24-hour ARV, and BMI as independent variables, only BMI showed statistically significant independent positive associations with LVMI (P=.028). Results of our study showed that currently used BPV indices (24-hour wBPSD and 24-hour ARV) are not clinically reliable parameters to identify children at risk for LVH. Apparent contribution of the 24-hour wBPSD parameter to LVMI is negligible and is secondary to its close correlation with BMI (ρ=0.335 P=.009).

An inverse correlation between TNF alpha serum levels and heart rate variability in patients with heart failure.

BACKGROUND: Recent evidence indicates that chronic heart failure (CHF) is accompanied by both activation of the immune system and autonomic imbalance. There is a growing body of evidence that increased levels of proinflammatory cytokines and other inflammatory markers have important roles as mediators of disease progression and markers of mortality in patients with CHF. OBJECTIVE: The aim of this study was to investigate connection between autonomic imbalance [obtained by analysis of heart rate variability (HRV)] and activation of the immune system [as measured by serum levels of tumor necrosis factor (TNF)-α] in patients with chronic heart failure. MATERIALS AND METHODS: This cross-sectional study included 21 patients with CHF and 8 age- and gender-matched healthy control subjects. We assessed HRV by 24-hour electrocardiographic Holter monitoring and measured serum levels of TNF-α using an enzyme-linked immunosorbent assay. Clinical assessment and echocardiography were also performed. RESULTS: There was an inverse correlation between serum level of TNF-α and a time-domain parameter of HRV - SDNN (r=-0.542, p<0.05). A similar result was found for HRV triangular index, a geometric measure of HRV (r=-0.556; p<0.05). The correlation was stronger for subjects with a diabetes mellitus, females, and TNFA2 allele carriers (an "A" at position -308A). The pNN50, indirect marker of cardiac vagal activity, was not significantly associated with serum concentration of TNF-α. CONCLUSIONS: In conclusion, the results of the present study indicate that increased serum TNF-α level is significantly associated with reduced HRV indices, suggesting that activation of the immune system in patients with CHF is closely related to autonomic imbalance.

Population pharmacokinetics of bisoprolol in patients with chronic heart failure.

PURPOSE: The aim of the study was to develop a population pharmacokinetic (PK) model for clearance of bisoprolol in patients with congestive heart failure (CHF). METHODS: Parameters associated with the plasma concentrations of bisoprolol at steady-state were analyzed in 61 patients (mean age 66.21 ± 9.49 years; mean total body weight 8.90 ± 12.26 kg) with CHF using non-linear mixed-effect modeling (NONMEM). A validation set of 17 patients with heart failure was used to estimate the predictive performance of the pharmacokinetic model. RESULTS: The typical mean value for bisoprolol clearance (CL), estimated by the base model (without covariates), in our population was 11.4 l h(-1). In the full model, covariates such as bisoprolol total daily dose (DD) and creatinine clearance were included. The final regression model for the clearance of bisoprolol was the following: CL (l h(-1)) = 4.68 + 0.859 * DD. CONCLUSION: The derived PK model describes the clearance of bisoprolol in patients with CHF, showing that the total daily dose of bisoprolol is the most important covariate. This finding will provide the basis for future PK studies on beta blockers in this specific patient population and lead to better overall management of heart failure.

[Association between chronic periodontitis and serum lipid levels].

BACKGROUND/AIM: Periodontitis is a local inflammatory process mediating destruction of periodontal tissues triggered by bacterial insult. However, this disease is also characterized by systemic inflammatory host responses that may contrbute, in part, to the recently reported increased risk for systemic diseases, including an altered lipid metabolism. On the other hand, many people in the world are affected by hyperlipidemia, which is a known risk faktor for atherosclerosis. The aim of this study was to determine the relationship between periodontal disease and blood lipid levels. METHODS: A total of 50 patients with periodontitis included in this study had no documented history of recent acute coronary events. The healthy, non-periodontal subjects (comparison group) comprised 25 subjects. All the patients were periodontology examined and completed a medical history. Dental plaque index, probing depth, gingival index bleeding on probing and clinical attechment levels were recorded. Blood samples were taken on admission for measurements of serum total cholesterol, triglycerides, hight density lipoprotein cholesterol (HDL-cholesterol), and low density lipoprotein cholesterol (LDL-cholesterol). RESULTS: The obtained results showed that mean levels of cholesterol (6.09 +/- 1.61 mmol/L), triglycerdes (2.19 +/- 1.67 mmol/l) and LDL cholesterol (4.09 +/- 1.40 mmol/L) in individuals with periodontitis were higer, and levels od HDL (1.43 +/- 0.51 mmol/L) was lower than those of individuals without periodontitis (4.86 +/- 1.37; 1.14 +/- 0.71; 3.18 +/- 0.64; 1.53 +/- 0.32 mmol/L, respectively). CONCLUSION: This study confirms a significant relationship between periodontal disease, regardless its intensity, and blood lipid levels in the studied population. The results imply that periodontitis may be a risk factor and may contribute to the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). However, future prospective randomized studies have to determine whether periodontal disease is a risk factor for the occurence of CVD.

Frequency and characteristics of myocardial ischemia recorded during stress echocardiography in patients with high coronary risk.

BACKGROUND/AIM: Ischemic heart disease is the major cause of morbidity and mortality in the world as well as in our country. Ischemic heart disease has the multifactorial origin and the presence of several risk factors increases the risk of myocardial ischemia. The aim of the study was to evaluate the frequency and characteristics of myocardial ischemia in asymptomatic subjects with two or more risk factors for coronary artery disease during stress echocardiography. METHODS: In 240 high risk asymptomatic subjects (an absolute risk of fatal cardiovascular disease of more than 5%, according to the Systemic Coronary Risk Evaluation Chart), the exercise stress echocardiography test was performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality (WMA). The wall motion score index was calculated before and after the exercise stress echocardiography. RESULTS: During exercise stress echocardiography, in 36 (15%) subjects WMA occurred. Out of 36 subjects with myocardial ischemia, in 10 (27.8%) subjects WMA and ST segment depression were accompanied with the first occurrence of chest pain (the subgroup with symptomatic myocardial ischemia), in 20 (55.6%) subjects WMA and ST segment depression were detected and in 6 (16.6%) subjects only WMA occurred (the subgroup with silent myocardial ischemia). There were no significant differences between the subgroups with symptomatic and silent myocardial ischemia with regard to exercise tolerance, heart rate at the onset of WMA, and time to the onset of WMA, but the wall motion score index was significantly higher in the subjects with symptomatic myocardial ischemia (p < 0.01). In all the individuals with symptomatic myocardial ischemia, significant stenosis of the coronary arteries was found by coronary angiography. Out of 26 subjects with asymptomatic myocardial ischemia, coronary angiography was performed in 18 and significant stenosis of the coronary arteries was diagnosed in all of them. The number and grade of coronary stenosis in subjects with symptomatic and silent myocardial ischemia were similar. CONCLUSION: The obtained results presented the incidence of myocardial ischemia in 15% of asymptomatic subjects with high coronary risk during stress echocardiography. Silent myocardial ischemia was markedly more frequent than symptomatic one, but in the subjects with symptomatic ischemia, the wall motion score index was significantly higher.

Function of the left ventricular myocardium in patients with systemic sclerosis.

Deposits of myocardial fibrosis are the principal cause of myocardial dysfunction and poor prognosis in the patients with systemic sclerosis. Our aim was to assess whether there are changes in regional function of the left ventricular myocardium in female patients with systemic sclerosis without clinical signs and symptoms of cardiovascular disease. The study included 23 female patients with systemic sclerosis (without cardiovascular disease and with normal global systolic and diastolic function of the left ventricle) and 21 healthy female controls. In both groups, pulsed wave tissue Doppler imaging was done at rest and during exercise stress test echocardiography. The myocardial function was assessed from the basal segments in systola and diastola. The level achieved and duration of exercise tests were significantly reduced in the patients with systemic sclerosis compared to the controls (P < 0.001 for both). The patients had significantly lower baseline regional systolic (P < 0.02) and diastolic (P < 0.001) myocardial functions, which became even more evident after the exercise test. During the test, those with systemic sclerosis demonstrated a smaller increase of systolic (20.6%) and diastolic (6.5%) function compared to the controls (systolic by 32.3% and diastolic by 25.0%). Quantification of regional function of the left ventricular myocardium using pulsed wave tissue Doppler imaging demonstrated an impaired systolic and diastolic myocardial function in the female patients with systemic sclerosis who had no clinical signs and symptoms of a cardiovascular disease.

Impact of reversible myocardial ischaemia on nitric oxide and asymmetric dimethylarginine production in patients with high risk for coronary heart disease.

BACKGROUND: The aim of the present study was to assess the impact of reversible myocardial ischemia, provoked by acute physical activity during an exercise stress echocardiography (ESE), on nitric oxide (NOx) and asymmetric dimethylarginine (ADMA) production in patients with high risk for coronary heart disease (CHD). MATERIAL/METHODS: An overall of 45 patients (27 men, 18 women; mean age, 55.87+/-6.39 years), was enrolled in the study and assigned into groups according to sex, CHD risk factors (RF), wall motion score (WMS), and diabetes mellitus (DM). An ESE was performed on an ergocycle, using a standardized protocol. The modified Saville-Griess method was used to determine NOx concentration. Production of ADMA was evaluated by high-performance liquid chromatography with fluorescent detection. RESULTS: A significant increase of NOx was observed in men (P<.05) and patients with stable WMS (P<.01), as well as its decrease in patients with increased WMS, whereas ADMA significantly increased in both sexes (P<.001 and P<.01 in men and women, respectively), independently of CHD risk (P<.05 and P <.001 in 1-2 RF and > or =3 RF groups, respectively), presence of DM (P<.001 and P<.01 in no-DM and DM groups, respectively), and WMS dynamic (P<.05 and P<.001 in WMS stable and WMS increased groups, respectively). The WMS was significantly higher in the > or =3 RF group (P<.01) after ESE and significantly increased in both sexes (P<.001 and P<.01 in men and women, respectively), with no regard to DM (P<.001 and P<.01 in no-DM and DM groups, respectively). CONCLUSIONS: The results of the present study clearly demonstrated a significant increase of NOx in patients with stable WMS and its decrease in patients with increased WMS after ESE, compared with the resting condition, as well as a significant increase of ADMA both in patients with stable WMS and those with increased WMS, irrespective of sex and CHD risk. A significant increase of WMS was observed in the > or =3 CHD RF group, in both sexes, with no regard to the presence of DM.

Heart rate variability in infants with central coordination disturbance.

Despite a remarkable medical progress in the field of Developmental Medicine and Child Neurology, early identification of infants at risk for permanent motor disabilities still presents challenge for both clinicians and researchers. As an indicator of cardiac autonomic control, it was shown that heart rate variability (HRV) might reflect not only sympathetic or parasympathetic activity but also functional integrity of the central nervous system (CNS). Furthermore a pattern of HRV was demonstrated to correlate with motor developmental outcome in high risk infants. The purpose of this study was to analyze the clinical usefulness as well as predictive value of time-domain HRV parameters in infants with central coordination disturbance. The study included 35 infants with central coordination disturbance and 37 healthy age and sex-matched controls. Time-domain HRV indices were analyzed from 24-h electrocardiography recordings. We found significantly lower values of SDNN, SDANN and RMSSD parameters in infants with central coordination disturbance compared to controls. Additionally, logistic regression analyses demonstrated independent predictive value of parameters SDNN and SDANN in infants who subsequently developed cerebral palsy (CP). By performing receiver operating characteristic (ROC) analyses, the optimal cut-off value of SDNN<=48ms predicted CP with a sensitivity of 68.7% (95% CI 41.4-88.9) and specificity of 84.2% (95 CI 60.4-96.4) while the optimal cut-off value of SDANN<=41ms predicted CP with a sensitivity of 87.5% (95% CI 61.6-98.1) and specificity of 57.9% (95 CI 33.5-79.7). We are in opinion that time domain HRV analysis could be helpful clinically as well as a prognostic tool in infants with central coordination disturbance.

Heart rate variability in children with exercise-induced idiopathic ventricular arrhythmias.

Ventricular arrhythmias (VAs) are common pediatric rhythm disorders requiring comprehensive laboratory evaluation. Although usually idiopathic, implying a benign character and favorable prognosis, the initial clinical approach is still not established in all cases. Considering their prognostic significance, exercise-induced (precipitated or aggravated) VAs usually require additional diagnostics, treatment, and follow-up. A number of reports have presented experimental and clinical evidence that increased sympathetic activity can initiate, or at least facilitate, VAs. Recent data highlight the relationship between exercise-induced idiopathic VAs (IVAs) and the long-term risk of cardiovascular death. The aim of this study was to assess the utility of heart rate variability (HRV) analysis as a noninvasive method for estimating autonomic nervous activity in children with exercise induced IVAs. The study included 42 children with IVAs, who were divided into two groups: children with exercise induced (precipitated or aggravated) IVAs and children with exercised-suppressed IVAs. Time-domain HRV parameters were analyzed from 24-h ambulatory electrocardiography recordings, and the majority of children underwent an exercise stress test using the McMaster protocol. The results of this study showed no significant changes in parasympathetic index, i.e., the square root of the mean of the sum of the squares of the differences between adjacent NN intervals (the length between two successive heartbeats) between the groups examined. On the other hand, we observed diminished time-domain values for the standard deviation of all adjacent NN intervals, as well as diminished time-domain values for standard deviation of the averages of NN intervals in all 5-min segments in the group of children with exercise-induced IVAs, implicating increased sympathetic activity in such individuals. HRV analysis could be a helpful diagnostic method, giving useful information regarding cardiac autonomic control in some children with exercise-induced IVAs.

Impact of interval versus steady state exercise on nitric oxide production in patients with left ventricular dysfunction.

AIM: The aim of the present study was to assess the impact of the interval exercise training (IET) vs. steady state exercise training (SSET) on nitric oxide production, through changes of circulating blood markers of endothelial function, including stable end-products of nitric oxide (NOx) and S-nitrosothiols (RSNOs) in patients with left ventricular dysfunction (LVD). PATIENTS AND METHODS: The impact of the IET vs. SSET on NOx and RSNOs production was assessed in a total of 31 (25 male, 6 female) patients with LVD (ejection fraction <40%), who were admitted to our residential rehabilitation centre. Patients were randomised into an IET group (n=18; 15 min interval exercise sessions, 2 times daily) and an SSET group (n=13; 5-10 min steady state exercise sessions, 2 times daily), and exercised every day over a period of 3 weeks. The modified Saville-Griess method was used to determine NOx and RSNOs concentrations. RESULTS: A significant increase was observed both for NOx (P < 0.05) and RSNOs (P < 0.001) in the IET group, as well as for RSNOs in the SSET group (P < 0.001). Both training methods were observed to significantly improve exercise capacity, as demonstrated for increased workload (P < 0.001 and P < 0.05 for the IET and SSET groups, respectively) and duration (P < 0.001 and P < 0.01 for the IET and SSET groups, respectively) of the exercise stress test at the end of the study. CONCLUSION: The results of the present study have demonstrated an increased nitric oxide production and improved exercise capacity in patients with left ventricular dysfunction, who were engaged in an interval exercise programme for three weeks, and clearly indicated an advantage of interval compared to steady state training method for cardiovascular rehabilitation.

[Serum concentration of soluble adhesive molecules in patients with different forms of coronary artery disease].

BACKGROUND/AIM: Vascular cell adhesion molecules-1 (VCAM-1) and intercellular cell adhesive molecules-1 (ICAM-1) play an important role in developing and progression of coronary atherosderosis. The aim of the paper was to compare concentrations of soluble forms of VCAM-1 and ICAM-1 in patients with different clinical presentations of coronary artery disease (CAD) and patients without CAD. METHODS: Blood samples were taken from 25 patients with acute myocardial infarction (AMI), 25 patients with unstable angina pectoris (UAP), 25 with stable angina pectoris (SAP) and from 15 control patients without CAD, and concentrations of solubile adhesive molecules (VCAM-1, ICAM-1) were determined. RESULTS: Obesity was more prominent in the NAP than in the SAP and the control patients (p < 0.05). There were no significant differences in gender distribution, age, duration of the CAD and body mass index between the groups. Hypertension and diabetes mellitus type 2 were more frequent in the CAD patients than in the controls (p < 0.01). Family history of the CAD was more frequent in the AMI and the UAP group than in the controls (p < 0.05). Serum concentrations of VCAM-1 was similar in the patients with AMI (955.9 +/- 117.8 ng/mL), UAP (952.4 +/- 139.1 ng/mL) and SAP (931 +/- 169.8 ng/mL), and significantly higher in these groups compared with the controls (823.4 +/- 97.6; p < 0.05, p < 0.05 and p < 0.1 respectively). Serum concentration of ICAM-1 was similar in the patients with AMI (699.2 +/- 125.6 ng/mL), UAP (727.6 +/- 171.8 ng/mL) and SAP (697.5 +/- 165.6 ng/mL), and significantly higher in these groups compared with the controls (583.4 +/- 86.6; p < 0.1, p < 0.05 and p < 0.1 respectively). CONCLUSION: Increased concentrations of VCAM-1 and ICAM-1, as markers of inflammation, showed the importance of inflammatory processes in development of atherosclerosis and clinical expresion of CAD. Measurement of soluble ICAM-1 and VCAM-1 concentrations is a usefull indicator of atherosclerosis presence but not severity of CAD clinical presentation.

[Evaluation of myocardial function in the presence of left ventricular hypertrophy in athletes and hypertensive patients].

INTRODUCTION: Myocardial hypertrophy of the left ventricle may be of physiological or pathological nature. Distinction of these two types of hypertrophy is sometimes not easy and represents a diagnostic challenge. The aim of the study was to assess global diastolic and regional systolic and diastolic myocardial function in the presence of left ventricular hypertrophy in athletes and hypertensive patients. MATERIAL AND METHODS: In 18 male hypertensive patients and 14 male athletes global diastolic left ventricular function and regional systolic and diastolic myocardial function of septum and posterior wall were investigated by pulsed wave tissue Doppler imaging. RESULTS: Ejection fraction and left ventricle mass index did not differ significantly between two groups. Hypertensive patients were found to have diastolic dysfunction while athletes had normal left ventricular diastolic function (the difference between the groups was P < 0.00001). Index of regional diastolic function of septum as well as of the posterior wall was significantly less in hypertensive patients than in athletes (P < 0.00001 for both). In spite of the normal global systolic function the regional systolic function of septum and posterior wall was significantly less in hypertensive patients than in athletes (P < 0.02 for both). CONCLUSION: The present results show significantly less global and regional diastolic function of hypertrophied myocardium in hypertensive patients than in athletes. In the presence of preserved left ventricular systolic function, the quantification of myocardial velocity revealed significantly lower regional systolic function of septum and posterior wall in hypertensive patients than in athletes.