The genetics of antiplatelet drug resistance.

Platelets have a central role in the development of arterial thrombosis and subsequent cardiovascular events. An appreciation of this complex process has made antiplatelet therapy the cornerstone of cardiovascular disease management. However, numerous patients will experience a recurrent atherothrombotic vascular event despite adequate antiplatelet therapy. Individual differences in the rate of platelet activation and reactivity markedly influence normal hemostasis and the pathological outcome of thrombosis. Such an individual variability is largely determined by environmental and genetic factors. These are known to either hamper platelets' response to agonists, and thereby mimic the pharmacological modulation of platelet function or mask therapy effect and sensitize platelets. In this article, we reviewed the antiplatelet mechanisms of aspirin and clopidogrel and the possible role of different polymorphisms, which may affect the efficacy of antiplatelet therapy. Heterogeneity in the way patients respond to aspirin and clopidogrel may in part reflect variation in cyclooxygenase (COX)-1, COX-2, glycoprotein (GP) Ib alpha, GP Ia/IIa, GP IIb/IIIa, UGT1A6*2, P2Y(1), P2Y(12), CYP2C9, CYP3A4 and CYP3A5 genotypes.

[Successful surgical treatment of ruptured left ventricular aneurysm]. / Rupturált bal kamra aneurysma sikeresen operált esete.

Authors report on the successful surgical treatment of a ruptured left ventricular aneurysm that resulted in cardiogenic shock. Pathogenesis and complications of left ventricular aneurysm as well as the diagnostic and treatment modalities are summarized. Authors emphasize that the quick and close co-operation between their departments was a prerequisite of the success.

[The role of transesophageal echocardiography in the detection of coronary anomalies and anatomical variations]. / A transoesophagealis echokardiográfia szerepe a koszorúér fejlödési rendellenességek és anatómiai variációk kimutatásában.

OBJECTIVES: The aim of the study is to examine the role of transesophageal echocardiography (TEE) in the diagnosis of anomalies and anatomic variations of the coronary arteries. BACKGROUND: In the past, coronary angiography was the only method for diagnostic confirmation in all cases with coronary anomalies, but even during invasive procedures diagnostic difficulties could and can emerge. The different, varying origin of aberrant coronary arteries can prolong the diagnostic procedure, therefore can increase the irradiation time. So every method which seems to be suitable for diagnosis of suspected coronary anomalies can be helpful. METHODS: The origin and course of anomalous coronary arteries were studied by TEE and coronary angiography during a six-month period. RESULTS: We found 16 patients (2.8%) with coronary anomalies or variations by angiography, the diagnosis of which was technically difficult. Seven of these had TEE examination too. All seven anomalous origins proven angiographically and 2 of the 2 anomalous courses in the relation to the great vessels were diagnosed by TEE. (In two, the left circumflex originated from the right sinus of Valsalva, in two we found anomalous separate origin of left circumflex coronary artery from the left sinus, in another two a common ostium of the left anterior descending and circumflex artery from the left sinus and in one an accessory artery from the non-coronary sinus.) CONCLUSIONS: TEE in a useful test to diagnose the origin of anomalous coronary arteries and confirming their course in relation to the great arteries.

[Comparison of invasive and non-invasive measuring of blood pressure in patients following open heart surgery]. / Invasiv és nem invasiv úton mért vérnyomás összehasonlítása szívsebészeti betegekben.

Accuracy of blood pressure measurements with a new noninvasive ambulatory blood pressure monitor (Meditech KFT Budapest) was studied in 12 postoperative patients following open heart surgery. We compared 532 systolic and diastolic blood pressure recordings taken simultaneously both invasively and noninvasively. The values obtained noninvasively were subtracted from the corresponding values obtained invasively, and the differences were assessed according the British Hypertension Society recommendations. Values obtained with the two methods demonstrated good correlation (R: 0.85; p < 0.0001). 60 per cent of the differences in diastolic and 76 per cent of the differences in systolic blood pressure recordings fell into the range of +/- 5 mmHg. Thus the accuracy of diastolic blood pressure measurements was classified as "A" (characteristic fo the best equipment) and those of the systolic recordings was classified as "B" (characteristic of good equipment). Based on our findings the new blood pressure monitor provides accurate recordings and its use is highly recommended in the everyday practice.

Prospective evaluation of thallium-201 reinjection in single-vessel coronary patients undergoing coronary bypass surgery.

Twenty-two patients with single-vessel left anterior descending coronary artery disease were investigated by means of dipyridamole stress thallium-201 myocardial perfusion scintigraphy, using single photon emission tomography (SPET), 1 week before and 2-5 weeks after coronary bypass surgery. The dose of dipyridamole was 0.56 mg/kg, and the injected activity of 201Tl was 74 MBq. Before surgery, and after completion of the redistribution study, a further 37 MBq of 201Tl was injected. Ten minutes and 1 h later, repeated SPET imaging were performed. SPET images were evaluated both subjectively and semiquantitatively, using a five-grade segmental defect score system, with higher scores for more severe perfusion defects. Before surgery, the 3-h redistribution images revealed complete or partial persistence of the perfusion defects in all patients. On the images taken 10 min after reinjection, these defects were completely filled in four cases, and partially filled in ten cases. Further positive changes were observed on the 1-h post-reinjection images in four cases. Three of the 1-h post-reinjection images exhibited a paradox redistribution. The stress images after surgery corresponded well to the 201Tl distribution on the preoperative 1-h post-reinjection images in 11 cases. The average of the segmental defect severity scores was 17.0 after stress, 10.1 at rest, 7.1 10 min after reinjection and 6.4 1 h after reinjection. After surgery, the average of both the post-stress and the 3-h redistribution scores was 3.1.(ABSTRACT TRUNCATED AT 250 WORDS)