IMPACT OF EARLY EXERCISE-BASED CARDIAC REHABILITATION ON HOSTILITY, ITS BEHAVIORAL COMPONENTS AND DISEASE PERCEPTION IN PATIENTS AFTER MYOCARDIAL INFARCTION.

OBJECTIVE: Aim: Hostility and its behavioral components, anger and aggression are psychosocial risk factors for coronary heart disease. The purpose of the study was to evaluate the effectiveness of physical training on the level of negative emotions, the cognitive aspect of adaptation to disease and physical capacity in patients after MI who participated in cardiac rehabilitation. PATIENTS AND METHODS: Materials and Methods: We enrolled 60 post-MI men and women in the study. They underwent an 8-week training program. Before and after completion of trainings patients underwent exercise test and a psychological examination.The Buss-Perry Aggression Questionnaire and the Brief Illness Perception Questionnaire were performed with results analysis in the entire group and in subgroups of men, women, patients under 60 years of age (younger) and over 60 years of age (older). RESULTS: Results: After rehabilitation a significant reduction in the general level of negative emotions was found in younger: 67.8±4.6 vs 63.9±3.7 points (p< 0.01). Similarly, a significant reduction in the sense of the impact of the disease on life was found only in younger 6.96±0.5 vs 5.48±0.5 points (p<0.01). There was a significant improvement in overall adaptation to the disease in women from 40.6±2.2 to 35.7±1.9 points (p < 0.05).Moreover,patients with higher levels of negative emotions had more difficulty adapting to the disease r=0.361, p<0.01. Physical capacity increased significantly in all groups. CONCLUSION: Conclusions: Participating in cardiac rehabilitation improved physical capacity, beneficially contributed to a decrease in negative emotions and had a positive effect on disease adaptation but only in younger post -MI patients.

Impact of exercise-based cardiac rehabilitation on attitude to the therapy, aims in life and professional work in patients after myocardial infarction.

BACKGROUND: Comprehensive cardiac rehabilitation aims to restore pathophysiological and psychosocial consequences of myocardial infarction (MI). The aim of the study was to assess how exercise-only-based cardiac rehabilitation (ECR) influences the attitude to the therapy (ATT), to the aims in life and professional work (AAL) amongst men and women after MI. MATERIAL AND METHODS: The study comprised 44 post-MI patients: 28 men and 16 women, mean age 58±10 years old, referred to ECR. Patients underwent 24 interval cycle ergometer trainings 3 times a week. At the beginning and after the training program (TP) each patient underwent exercise stress test (EST) and was scored to ATT and ALL based on the Psychological Effects of Rehabilitation Score Scale (PERSS) according to Tylka and Makowska. The analysis covered: 1) EST findings: maximal workload and test duration (min), 2) ATT and AAL based on PERSS, 3) resuming professional work. RESULTS: Exercise capacity improved significantly after TP. Attitude to the aims in life and professional work significantly increased in the whole group (4.4±2.8 vs. 5.1±2.4, p < 0.01) and separately in men (4.5±2.9 vs. 5.1±2.5, p < 0.05) and women (4.3±2.6 vs. 5.0±2.0, p < 0.05). Attitude to the therapy did not change significantly in the whole group (5.6±2.8 vs. 6.0±2.8) and in men (5.9±2.9 vs. 6.0±2.9), but increased significantly in women (5.0±2.5 vs. 6.1±2.7, p < 0.05). Professional work was resumed, averagely by 86.4% of all patients (85.7% men and 87.5% women). CONCLUSIONS: Physical training beneficially influenced post-MI men's and women's attitude to the aims in life, professional work and attitude to the therapy in women. Med Pr. 2019;70(1):1-7.

Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology.

Electrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk strati- fication in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction.

AIM: The aim of the study was to assess the effectiveness of exercise training on depression, anxiety, physical capacity and sympatho-vagal balance in patients after myocardial infarction and compare differences between men and women. METHODS: Thirty-two men aged 56.3±7.6 years and 30 women aged 59.2±8.1 years following myocardial infarction underwent an 8-week training programme consisting of 24 interval trainings on cycloergometer, three times a week. Before and after completing the training programme, patients underwent: depression intensity assessment with the Beck depression inventory; anxiety assessment with the state-trait anxiety inventory; a symptom-limited exercise test during which were analysed: maximal workload, duration, double product. RESULTS: In women the initial depression intensity was higher than in men, and decreased significantly after the training programme (14.8±8.7 vs. 10.5±8.8; P<0.01). The anxiety manifestation for state anxiety in women was higher than in men and decreased significantly after the training programme (45.7±9.7 vs. 40.8±0.3; P<0.01). Of note, no depression and anxiety manifestation was found in men. Physical capacity improved significantly after the training programme in all groups, and separately in men and in women. Moreover, an 8-week training programme favourably modified the parasympathetic tone. CONCLUSIONS: Participating in the exercise training programme contributed beneficially to a decrease in depression and anxiety manifestations in women post-myocardial infarction. Neither depression nor anxiety changed significantly in men. The impact of exercise training on physical capacity and autonomic balance was beneficial and comparable between men and women.

The influence of water-based training on arrhythmia in patients with stable coronary artery disease and preserved left ventricular function.

BACKGROUND: Water immersion may cause adverse cardiovascular events, including arrhythmias in patients with damaged cardiac muscle, e.g. with cardiac failure. So far, there have been rather few reports on arrhythmia induced by water training in patients with coronary artery disease (CAD). The aim of the study was to assess the influence of exercise training in moderately cold water (28-30°C) on arrhythmia and physical capacity in stable CAD patients with preserved left ventricular (LV) function. METHODS: Sixty-two post-myocardial infarction male patients, mean age 50.9 ± 7.9 years, participated in 16 water-based trainings (WBT), which lasted 55-min, twice a week in water at 28-30°C. Each subject underwent 24 h Holter on-land monitoring (Holter-24) once during the study and twice in-water Holter monitoring (Holter-W) during WBT. Before and after WBT cardiopulmonary exercise test (CPET) was performed. The following parameters were analyzed: peak oxygen consumption (peak VO2), mean number of ventricular ectopic beats (VEBs) and supraventricular ectopic beats (SVEBs) during Holter-24 and Holter-W, the percentage of men who developed arrhythmia during CPET vs. Holter-24 and vs. Holter-W. RESULTS: WBT significantly improved patients' physical capacity, and more often provoked arrhythmia, mainly SVEBs, than CPET or daily activity assessed during Holter-24. During WBT 58% men developed VEBs and 62% SVEBs. CONCLUSIONS: 1. WBT provoked arrhythmias significantly more often than did CPET and normal daily activity. 2. Owing to WBT patients improved their physical capacity which was still maintained at 1-year follow-up.

Hybrid model of cardiac rehabilitation in men and women after myocardial infarction.

BACKGROUND: A relatively new alternative for post-myocardial infarction (MI) patients' care is the hybrid cardiac rehabilitation (CR) consisting of ambulatory and home-based parts. The aim of the study was to compare the influence of CR on physical capacity, safety, adherence and return to work in post-MI male and female patients with preserved left ventricular systolic function, and to assess who benefited more from this model of trainings. METHODS: The study comprised 57 men aged 54.5 ± 7.5 years and 30 women aged 52.2 ± 6.7 years after MI. All subjects underwent an 8-week training program consisting of 24 interval trainings. The first 10 trainings were conducted in an out-patient clinic, then both groups did their training at home with TeleECG monitoring. At the beginning and after trainings all patients underwent a symptom-limited exercise stress test. Assessment included results of exercise tests. Moreover, a comparative analysis of adherence and returning to work in post MI female and male patients was performed. RESULTS: We found that trainings led to a significant improvement in physical capacity in all patients based on exercise test. When the training effects were compared between men and women, no significant differences were observed. The percentage of patients returning to work was higher in men than in women (78.9% vs. 50%, p < 0.01). CONCLUSIONS: 1. Hybrid rehabilitation resulted in a comparable improvement in physical capacity in post-MI low-risk male and female patients. 2. Although hybrid rehabilitation facilitated patients' adherence to the training program, their return to work was significantly greater only in post-MI men.

Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study.

BACKGROUND: Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients' acceptance of and adherence to HTCR. METHODS: The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes - in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR. RESULTS: HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients. CONCLUSIONS: HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.

Comparison between hybrid and standard centre-based cardiac rehabilitation in female patients after myocardial infarction: a pilot study.

BACKGROUND: Despite the known benefits of cardiac rehabilitation (CR) for patients with stable coronary artery disease, it is neglected, especially in women. Home-based programmes may increase adherence to CR. AIM: To compare the effectiveness of centre-based CR with a hybrid model of training, partly out-patient and partly home-based and tele-monitored, in terms of physical capacity and adherence in post-myocardial infarction (MI) women with preserved left ventricular function. METHODS: 53 post-MI female patients, aged 51.3 ± 7.6 years underwent an eight-week training programme (TP) consisting of 24 interval trainings. The first ten trainings were performed in a hospital, then 33 patients (Gruop A) continued them in the centre, the remaining 20 (Group B) did tele-monitored walking training at home (hybrid model). Before and after completing CR, all patients underwent a symptom-limited treadmill exercise stress test during which the analysis included: workload (METs), duration (min), heart rate (HR, bpm), double product (mm Hg/min) at rest and during effort, and HR recovery in the first minute after test. Adherence was reported as the number of trainings completed and the number of dropouts in two CR models. RESULTS: After CR, only workload (Group A: 6.5 ± 1.1 vs. 7.0 ± 1.4, p < 0.05; Group B: 7.4 ± 1.1 vs. 8.3 ± 1.4, p < 0.01) and duration (Group A: 4.7 ± 1.1 vs. 5.1 ± 1.2, p < 0.01; Group B: 8.1 ± 3.9 vs. 9.3 ± 4.2, p < 0.01) improved significantly in both groups. Comparing CR effects between both groups, no significant differences were observed. All patients completed TP. CONCLUSIONS: In post-MI women, a hybrid model of training improved physical capacity and was a similarly effective form of CR as a centre-based approach. A home-based tele-monitored programme facilitated our patients' adherence to CR.

Influence of warm­up ischemia on the effects of exercise training in patients with stable angina.

INTRODUCTION:  It is still unknown whether ischemia­inducing training in patients with stable angina is superior to the training conducted below the ischemic threshold (IT) according to the current guidelines. OBJECTIVES:  The aim of the study was to assess the influence of warm­up ischemia prior to training on the effects of training conducted either at or below the IT in patients with stable angina. PATIENTS AND METHODS:  Thirty male patients aged 56 ±8 years, after myocardial infarction, with stable angina and positive exercise test (ET1) were divided into 2 groups: group A included 18 patients with the warm­up effect, group B - 12 patients without this effect. All patients followed an 8­week interval training program (TP). The intensity of training was planned to reach the heart rate at the IT. Successive ETs were performed immediately after the TP (ET2), at day 3 (ET3), day 10 (ET4), and at 1 month (ET5).   RESULTS:  After the TP, there was a statistically significant improvement in group A in all analyzed variables except maximum ST depression (max STD). Maximal workload increased by 28%, walking distance by 24%, duration by 20%, and time to 1­mm STD by 28%. Max STD reduction amounted to 14% (P =0.13). The beneficial effect of training on exercise­induced ischemia was maintained for up to 10 days (ET4) and on physical capacity for up to 1 month (ET5). In group B, the TP did not affect time to 1­mm STD, but physical capacity improved significantly and was maintained for up to 1 month (ET5). CONCLUSIONS:  The warm­up effect appears to be necessary to attenuate myocardial ischemia after training. 

Mutant p53 cooperates with ETS2 to promote etoposide resistance.

Mutant p53 (mtp53) promotes chemotherapy resistance through multiple mechanisms, including disabling proapoptotic proteins and regulating gene expression. Comparison of genome wide analysis of mtp53 binding revealed that the ETS-binding site motif (EBS) is prevalent within predicted mtp53-binding sites. We demonstrate that mtp53 regulates gene expression through EBS in promoters and that ETS2 mediates the interaction with this motif. Importantly, we identified TDP2, a 5'-tyrosyl DNA phosphodiesterase involved in the repair of DNA damage caused by etoposide, as a transcriptional target of mtp53. We demonstrate that suppression of TDP2 sensitizes mtp53-expressing cells to etoposide and that mtp53 and TDP2 are frequently overexpressed in human lung cancer; thus, our analysis identifies a potentially "druggable" component of mtp53's gain-of-function activity.

[Physical training as an effective way to protect the heart against ischaemia]. / Trening fizyczny jako skuteczny sposób ochrony serca przed niedokrwieniem.

The findings from experimental animal studies show that regular physical trainings can protect via preconditioning the heart against the ischaemia-reperfusion (IR) injury. It is not clear if the cellular mechanism is the same as in the case of ischaemic preconditioning, but the final effect is the same, i.e. a stress stimulus, in this case a repeated effort leaves the heart with the 'memory', which translates into an increased resistance to ischaemia. At present, the precise mechanism responsible for training-induced cardioprotection is not clear. Candidate factors responsible for this cardioprotection are numerous and include collateral circulation development, enhanced ER stress proteins, increased COX-2 activity, increased heat shock protein (HSP-72) levels, increased activity of mitoK-ATP and sarcoK-ATP channels, and increased myocardial antioxidative capacity. The studies performed so far have suggested that MnSOD activity and increased sarcoK-ATP expression did play a role in exercise-induced cardioprotection. There may exist some other mechanisms responsible for this type of cardioprotection, but finding them will be possible only through further relevant studies. The paper presents the up-to-date knowledge in this field.

Two models of early cardiac rehabilitation in male patients after myocardial infarction with preserved left ventricular function: comparison of standard out-patient versus hybrid training programmes.

BACKGROUND: The key to increase the percentage of cardiac patients undergoing cardiac rehabilitation is to follow a well designed exercise programme at home. To maximise the benefits while minimising the risks of aggravating health status, home-based exercise should be tele-monitored. AIM: To compare the effects on physical capacity and sympatho-vagal balance of two types of early cardiac rehabilitation in post-myocardial infarction (MI) male patients: the hybrid model, partly out-patient and partly home-based and tele-monitored vs standard rehabilitation performed only in the out-patient setting. METHODS: Sixty two male patients aged 54.7 ± 6.9 years, mean 27.3 ± 13.5 days after MI with preserved left ventricular systolic function (EF > 50%) underwent an eight-week training programme consisting of 24 training sessions. After performing the first ten interval trainings on a cycloergometer, 30 patients (the hybrid group) exercised at home while being monitored via TeleECG, while 32 patients (the out-patient group) continued their rehabilitation in the out-patient clinic. At entry and after completion of the rehabilitation programme, all patients underwent a symptom-limited treadmill stress test. The following parameters were analysed: maximal workload (METs), exercise duration (ED, min), heart rate (HR, bpm), blood pressure (BP, mm Hg), double product i.e. product of HR and systolic BP at rest and at peak exercise (DP, mm Hg/min, HR × systolic BP), and HR recovery (HRR) in the first and second minute of the recovery period. RESULTS: Maximal workload (out-patient: 7.3 ± 1.4 vs 7.8 ± 1.2, p < 0.05; hybrid: 8.5 ± 1.8 vs 9.9 ± 2.2, p < 0.01) and ED (out-patient: 10.1 ± 2.0 vs 13.5 ± 1.4, p < 0.001; hybrid: 10.9 ± 3.6 vs 12.5 ± 4.1, p < 0.05) increased significantly in both study groups. The remaining parameters did not change significantly, except for HRR1 (22.1 ± 8.7 vs 29.5 ± 10.7, p < 0.01) and HRR2 (37.9 ± 9.5 vs 43.8 ± 10.7, p < 0.01), which improved in the hybrid group only. Moreover, there were no significant differences between the study groups when comparing the training-induced percentage changes in the analysed parameters. CONCLUSIONS: 1. Hybrid rehabilitation improved physical capacity and positively influenced the sympatho-vagal balance in post-MI male patients with preserved left ventricular systolic function. 2. The hybrid model was effective and comparable with standard out-patient-based programme.

Influence of exercise training on left ventricular diastolic function and its relationship to exercise capacity in patients after myocardial infarction.

BACKGROUND: The study's aim was to examine the effect of exercise training on left ventricular diastolic function (LVDF) and whether LVDF could predict an improvement in exercise capacity (EC) in post-myocardial infarction patients. METHODS: Forty-eight males, aged 56.4 +/- 7.2 years, with preserved left ventricular systolic function (LVSF) and mild diastolic dysfunction (the ratio of transmitral early left ventricular filling velocity to early diastolic mitral annulus velocity E/E' > 8 as the average of the septal and lateral annulus velocities), were assigned to either a training group (TG, n = 32) or controls (n = 16). Before, and at the end of the study, all patients underwent a cardiopulmonary test and echocardiography with tissue Doppler imaging (TDI). RESULTS: After a 4.5-month training program, maximal oxygen consumption increased significantly in TG (26.66 +/- 3.88 vs. 28.79 +/- 5.00 mL/kg/min, p < 0.0001). TDI-derived E/E' did not change after the training program. After dividing TG according to septal E/E's > 10 and < 10 and lateral E/E'l > 8 and < 8, exercise capacity improved significantly only in patients with E/E's < 10 and E/E'l < 8. CONCLUSIONS: A 4.5-month training program in post-myocardial infarction patients with preserved LVSF and mild diastolic dysfunction led to improved exercise capacity only in TG. The diastolic function did not change significantly. The improvement in exercise capacity was significantly greater in patients with a better LVDF measured by TDI.

'Warm-up' phenomenon in diabetic patients with stable angina treated with diet or sulfonylureas.

BACKGROUND: Classic sulfonyloureas (SUs) are known to attenuate ischaemic preconditioning. Gliclazide is an SU agent believed to be more protective. We assessed the effects of diet, glibenclamide, or gliclazide on the warm-up effect in type 2 diabetic patients with stable angina. METHODS: The study group consisted of 64 men, aged 54+/-5 years: 17 patients without diabetes (G I) and 47 diabetic patients: 16 patients treated with glibenclamide (G II), 16 with gliclazide (G III) and 15 patients treated with diet (G IV). After the baseline positive exercise test (ET1), all patients reexercised after 30-min rest (ET2). We analysed exercise duration (ED, s), time to 1 mm ST depression (T-STD, s), max STD (mm), heart rate-systolic blood pressure product at 1 mm STD, or ischaemic threshold (mmHg/min x 100) and the total ischaemic time (s). RESULTS: In G I, all analysed variables improved significantly during ET2 relative to ET1. Glibenclamide (G II) completely abolished the protective effect of exercise-induced ischaemia because only ED increased during ET2 (431 vs. 451, P<0.05). In G III, however, ED (486 vs. 537, P<0.001), T-STD (364 vs. 388, P<0.05) and max STD (2.5 vs. 2.0, P<0.05) improved significantly during ET2, whereas ischaemic threshold and total ischaemic time did not (PNS). In G IV, similar to G I, all variables improved significantly during ET2 relative to ET1. CONCLUSION: Warm-up effect is preserved in diabetic patients with stable angina treated with diet, partially preserved in gliclazide-treated and abolished in glibenclamide-treated patients.

Influence of physical training on cardiac performance in patients with coronary artery disease and exercise-induced left ventricular dysfunction.

OBJECTIVE: The aim of the study was to assess the influence of physical training on systolic and diastolic left ventricular (LV) function using seismocardiography (SCG) and its relationship to the exercise capacity in CAD patients with exercise-induced LV dysfunction. METHODS AND RESULTS: Eighty men aged 52.5 +/- 7.5 y with stable CAD were assigned to either a control group (CG, n = 40) or a training group (TG, n = 40).TG patients underwent a 4.5-month training programme (TP). Before and at the end of the study all patients underwent a cardiopulmonary test (CPET) and SCG. After TP the following CPET parameters improved significantly: duration (776 +/-120 vs. 879 +/- 89 s, P<0.001), METs (8 +/- 2 vs. 10 +/- 1, P<0.01), maxVO2 (22 +/- 4 vs. 25 +/- 3 ml/kg/min, P < 0.001). During SCG performed before (SCG(REST)) and immediately after each CPET (SCG(CPET)) the following variables improved significantly, but only in TG patients: the pre-ejection period (PEP; 126 +/- 15 vs. 119 +/- 14, P < 0.05 ms), PEP/LVET ratio (PEP/LV ejection time, ms; 0.42 +/- 0.08 vs. 0.38 +/- 0.06, P < 0.05). There was a negative correlation between training-induced changes in maxVO2 and PEP(CPET) (r =-0.4, P = 0.01) and PEP/LVET(CPET) (r =-0.52, P = 0.001), and a positive correlation between maxVO2 and LVET(CPET) (r = 0.51, P = 0.01). After TP, there was also a negative correlation between maxVO2 and isovolumetric relaxation time (ms; r =-0.46, P = 0.01). CONCLUSIONS: The training programme resulted in a significant improvement in the physical capacity and cardiac performance in CAD patients with exercise-induced left ventricular dysfunction. An improvement of systolic left ventricular function suggested an increase in exercise capacity.

Usefulness of seismocardiography for the diagnosis of ischemia in patients with coronary artery disease.

BACKGROUND: Seismocardiography (SCG) is a useful method for the detection of exercise-induced changes in cardiac muscle contractility which may occur during myocardial ischemia. The aim of this study was to compare the diagnostic accuracy of SCG with electrocardiographic exercise test (ETT) for diagnosis of ischemia in patients with angiographically proved coronary artery disease (CAD). METHODS: Seventy-seven male patients with CAD without myocardial infarction (MI), mean age 51+/-9 years, were subjected to SCG and ETT. A gender-matched control group consisted of 30 healthy volunteers aged 34+/-7 years. SCG was done simultaneously with resting supine 12-lead electrocardiography before and immediately after a symptom-limited ETT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of SCG were compared with ETT. Moreover, the diagnostic accuracy of both the methods was compared, with coronary angiography being the reference for the analysis. RESULTS: SCG was more sensitive (61.1% vs 44.2%, P<0.05) and accurate (70% vs 61%, P<0.05) method for detecting ischemia caused by coronary stenosis>or=50%, at least in one coronary artery compared to the ETT. However, ETT had better specificity than SCG (82.4% vs 76%, P<0.05). The PPV and NPV of SCG were significantly better than those obtained with ETT (77.9% vs 76%, P<0.05 and 63.4% vs 53.8%, P<0.05, respectively). Moreover, the concordant results of SCG and ETT improved the diagnostic accuracy of both methods. CONCLUSIONS: SCG appeared to be more sensitive for detecting ischemia caused by more than>or=50% stenosis of the main coronary artery compared to an electrocardiographic stress test. SCG was a useful ETT adjunct for selecting patients requiring coronary angiography.

[Cardiological rehabilitation--a chance of returning to work]. / Rehabilitacja kardiologiczna szansa powrotu do pracy zawodowej?

According to the definition of the World Health Organization (WHO) "rehabilitation is a comprehensive and coordinated application of medical, social, educational and occupational measures to adapt a sick person to new life and to assist in gaining the best possible physical fitness". With respect to patients with cardiovascular diseases, the significance of comprehensive cardiologic rehabilitation is particularly emphasized. Return to work is by some authors perceived as a marker of rehabilitation efficiency. At the 8th World Rehabilitation Congress held in Dublin in May 2004, Perk (Sweden) reviewed the literature addressing the issue of returning to work. Over the recent seventy years, 460 publications devoted to this topic have been published. They mainly focus on the proportion of persons who return to work after myocardial infarction, percutaneous angioplasty of coronary arteries or implantation of aortic-coronary stents as well as on factors contributing to this success. It has been revealed that rehabilitation is one of numerous factors. Interestingly, socioeconomic and psychological, but not medical, factors play the major role in assuring return to work. There are also other factors which play a role, such as age < 50 years, education, social support, physical efficiency, disease perception, work satisfaction, absence of clinical symptoms, depression, fear, relations between the management and employees, place of residence (rural or urban area), economic status, sense of disability, waiting time for surgical procedure (period shorter than 3 months increases the frequency of returning to work). The number of studies providing evidence that rehabilitation enhances a chance of returning to work is rather limited. The authors review the state-of-the-art in this area based on the available literature.

Co-segregation and heteroplasmy of two coding-region mtDNA mutations within a matrilineal pedigree.

The ENG1 Leber's hereditary optic neuropathy (LHON) family spans six generations and comprises more than 90 maternally related individuals. In this pedigree, the G:A LHON mutation at nucleotide position 11778 shows a complex pattern of segregation in which it is homoplasmic mutant in two branches, homoplasmic wildtype in another, and heteroplasmic in a fourth branch. In addition, there is co-segregation of the 11778 mutant allele and of a G:A silent polymorphism at nucleotide position 5471 in 18 of 19 family members. This co-segregation indicates that the two substitutions arose either simultaneously, or nearly so, in the same "founder" mtDNA molecule. However, the highly divergent mitochondrial allele ratios in the one family member suggest that there has been a complex origin and segregation "history" of these two substitutions. Taking all of the results into consideration, the evidence supports sequential single mutations at sites 5471 and 11778, in close temporal proximity, with subsequent segregation of the intermediate mutational genotype to high levels in one branch of the ENG1 LHON family. In other branches, either the double wildtype or double mutant genotype has become essentially homoplasmic.

Lightning strikes twice: Leber hereditary optic neuropathy families with two pathogenic mtDNA mutations.

OBJECTIVE: To report the clinical and mitochondrial genetic analyses of two families, each of which carries both the 11778 and 14484 Leber hereditary optic neuropathy (LHON) mutations in mitochondrial DNA. METHODS: In addition to detailed clinical histories, the complete sequence of the mitochondrial DNA (mtDNA) from each family was determined. RESULTS: A small Australian LHON family (Vic20) and a family from the United States carry the 11778 and 14484 LHON mutations. In addition to the optic neuropathy, one branch of the Baltimore LHON pedigree had a high incidence of a fatal infantile encephalopathy. In both families, the 14484 LHON mutation was homoplasmic, whereas the 11778 LHON mutation was heteroplasmic. CONCLUSIONS: There are no additional mtDNA sequence changes that explain the encephalopathy in the Baltimore LHON family, and a nuclear gene involvement is an alternative explanation that is supported by the available data. The ophthalmological characteristics and penetrance in the 11778 and 14484 "two-mutation" LHON families are not markedly more severe than those of classic LHON families who carry a single mtDNA mutation.

A high frequency of mtDNA polymorphisms in HeLa cell sublines.

The complete mtDNA sequences from the uncloned "founder" HeLa cells and from five sublines have been determined. These sequences all carry a common "core" of 38 single basepair alterations relative to the revised Cambridge Reference Sequence (CRS). The HeLa mitochondrial genome is of African descent and it is a member of the African L3 haplogroup. The sequence of the HeLa mtDNA resolves the uncertainty surrounding the mosaic composition of the original CRS for human mtDNA. Most importantly, we detected a total of eight polymorphisms that have arisen in the mtDNA coding region of different HeLa sublines. These observations suggest that HeLa mtDNA has a high rate of sequence divergence, relative to the phylogenetically-derived divergence rate for mtDNAs in the human population, which results from a relaxation of negative selection against the fixation of deleterious mutations. Furthermore, this high frequency of polymorphisms in HeLa mtDNA may reflect a process similar to the accumulation of somatic mtDNA mutations in human cancers. Preliminary analysis of single-cell derived subclone lines revealed the occurrence of another polymorphism and provided evidence for a large number of mtDNA segregation units.