[Changes in QT dispersion during the exercise test in women with syndrome X]. / Zmiany dyspersji QT w czasie wysilku u kobiet z kardiologicznym zespolem X.

UNLABELLED: The aim of the present study was to examine the effect of exercise test on QT dispersion (dQT) and to compare the result in women with syndrome X with women with coronary artery disease and normal subjects. We examined 53 women in mean age 54.2 +/- 9.2 who were divided into groups: 20 women with one-vessel coronary artery disease (group I), 19 women with syndrome X (group II) and 14 healthy control women (group III). All subjects underwent a modified Bruce protocol exercise test and QT intervals were measured manually at rest and peak exercise. The value of dQT was calculated as a difference between the longest and the shortest measured value in each of the 12 ECG leads. Corrected QT (dQTc) dispersion was measured after the QT interval was corrected with Bazett's formula. There were no significant differences in rest values of dQT between groups but rest dQTc was significantly greater in group I and II then in group III. We observed significant increase in dQT and dQTc on peak exercise in group I and II when compared with group III. CONCLUSION: At rest dQTc is significantly greater in women with syndrome X and coronary artery diseases in comparison with control subjects. The exercise caused increase in the value of dQT and dQTc both in women with syndrome X and coronary artery disease. The value of dQT and dQTc makes impossible to differentiate between women with syndrome X and women with coronary artery disease.

[Clinical outcome in patients after single vessel PTCA with multiple stent implantation]. / Ocena chorych leczonych angioplastyka wiencowa i implantacja dwóch i wiecej stentów do jednej tetnicy.

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

[QT dispersion in patients treated with repeated percutaneous transluminal coronary revascularization]. / Dyspersja QT u chorych leczonych powtórna przezskórna rewaskularyzacja miesnia sercowego.

In this study the group of 30 patients with coronary artery disease (mean age 55 +/- 7 years) were examined. All patients underwent repeated percutaneous transluminal coronary revascularisation (rePTCR) due to coronary artery restenosis after primary coronary angioplasty. QT dispersion (dQT) and the corrected QT dispersion (dQTc), obtained applying Bazett's (dQTB) and Hodge's (dQTH) formulas, were measured before rePTCR and 7 days after rePTCR. Standard 12-lead electrocardiograms, 25 mm/s speed, were used. QT dispersion, defined as a difference between maximal and minimal QT intervals, was manually measured. The significant decrease of dQT after rePTCA was observed. Mean dQT before rePTCR was 88.67 +/- 29.09 ms and 64.00 +/- 28.96 ms after rePTCR (p < 0.0001). The changes of dQTc (dQTB, dQTH) were similar. Mean values of dQTB before and after rePTCR were 92.97 +/- 34.40 ms and 65.42 +/- 29.80 ms respectively, and mean values of dQTH were 94.90 ms +/- 37.31 ms and 70.98 ms +/- 32.85 ms. It was also noted that the frequency of appearance of dQT exceeding 80 ms significantly decreased after rePTCR (dQT exceeded 80 ms in 17 cases before rePTCR vs 5 cases after revascularisation). Increased QT dispersion can be a marker of the coronary artery restenosis.