[Thallium scintigraphy of the myocardium in evaluation of patients with insulin resistance syndrome and microvascular angina pectoris]. / Táliová spect scintigrafia myokardu v hodnotení pacientov so syndrómom inzulínovej rezistencie a mikrovaskulárnou anginou pectoris.

Insulin resistance syndrom (IR) is often associated with the syndrome of microvascular angina pectoris (MVAP) or with coronary artery disease (CAD). The authors quantified distribution and washout of 201Tl in heart (C), lungs (L) and liver (H) to evaluate the results 201Tl stress (s) and redistribution SPECT in 50 patients. They compared 2 groups of patients with laboratory verified IR (MVAP and CAD) and control group (CG) of patients with normal coronarography without any symptoms of IR. In Patients with IR and MVAP were found significantly more frequent local perfusion abnormalities then in CG. The index sL/C calculated by ROI analysis is significantly lower in controls, then in CAD. The index sC/H is lower in patients with IR (MVAP significantly) then in CG. The washout of 201Tl in CAD myocardium decreased and in MVAP liver increased. 201thalium scintigraphy is useful for separation of patients with MVAP and local perfusion abnormalities. This findings had probably prognostic value in patients with IR.

[Insulin resistance and the coronary syndrome]. / Inzulínová rezistencia a koronárny syndróm.

The different diseases associated with the insulin resistance syndrome--diabetes mellitus or impaired carbohydrate tolerance, atherogenic lipoprotein phenotype, arterial hypertension and central type of obesity are the main risk factors of atherosclerosis. The reduced sensitivity of target tissues to the metabolic action of insulin (insulin resistance) is considered at present a separate risk factor. The authors analyze on the basis of a group of 210 coronarographic patients the influence of insulin resistance and associated etiopathogenetic risk factors on coronary lesions evaluated by the method of quantitative coronarography. From the results of the investigation ensues that insulin resistance is the most frequent metabolic deviation in patients with coronary disease whereby in the macrovascular group it was found in 74.3% and in the group with microvascular angina pectoris in 64.3% of the patients. Changes in the lipoprotein spectrum were a more frequent and earlier manifestation of insulin resistance than impaired carbohydrate metabolism. The change from functional changes of the vascular wall (impaired endothelium-dependent vasodilatation) to the development of an atheromatous plaque depends on the total number of cholesterol conveying lipoproteins assessed by means of the apoprotein B level and on the capacity of the reverse cholesterol transport, whereby both mechanisms are greatly influenced by insulin sensitivity. The degree of coronary affection evaluated by means of a coronary score, is in patients with manifest diabetes comparable with the affection in patients with insulin resistance without manifest diabetes and these two groups differ very significantly as to the extent and degree of affection from patients with a normal sensitivity to the effect of insulin.

[Relation between cytokines (TNF-alpha, IL-1 and 6) and homocysteine in android obesity and the phenomenon of insulin resistance syndromes]. / Vzt'ah cytokínov (TNF-alfa, IL-1 a 6) a homocysteínu k androidnej obezite a k fenoménom syndrómu inzulínovej rezistencie.

TNF-alpha (so-called cachectin), IL-1 and 6 are important regulating agents in the homeostasis of energy in the organism, as among others they control processes of apoptosis and thus also the volume of adipose and muscular tissues. They are produced not only in immunocompetent cells but also in adipocytes and muscle cells. The cytokine system is then activated not only in tumours and infections but elevated values were found also in obesity, NIDDM, in myocardial infarction and in advanced decompensated cardiac patients. By acting on phosphorylation of IRS-1 and PI-3 kinase TNF-alpha promotes significantly insulin resistance, causes deterioration of diabetes, as well as elevated body temperature, sleepiness and anorexia. In a group of 65 patients, mostly with android obesity, in hyperleptinaemic and insulin resistant probands with coronarographically confirmed microvascular angina pectoris (n = 22) or IHD, mostly after a myocardial infarction (n = 43) with one or more significant stenoses on the epicardial coronary arteries in half the patients positive or elevated TNF-alpha was found and in 28% also IL-6. This increase did not correlate however with BMI, the percentage of body fat, IRI and C peptide levels nor with cortisol and leptin levels. Insulin resistant subjects had more frequently elevated homocysteine and Lp(a) values which are further two independent risk factors of atherothrombogenesis. Hyperhomocysteinaemia can be favourably influenced by vitamin fortification of the diet or by administration of folate and pyridoxine (1 tablet per day) involving negligible financial costs.

[Percutaneous transluminal coronary angioplasty in the treatment of acute myocardial infarct]. / Perkutánní transluminální koronární angioplastika v lécbe akutního infarktu myokardu.

A patient with acute myocardial infarction can undergo at present one of the following reperfusion therapies: 1. Primary PTCA (as an alternative to thrombolytic treatment), 2. Emergency PTCA (when thrombolysis fails), 3. Elective PTCA (in spontaneous or post-exercise myocardial ischaemia). 4. Empirical PTCA (as prophylaxis of recurrent myocardial ischaemia). The authors submit their initial experience with the use of PTCA in the treatment of acute myocardial infarction. In a group of eight patients (5 men and 3 women), age 33-72 years (mean 51 years) where primary PTCA (5 patients) and emergency PTCA (3 patients) was used.