[Associations between acute heart failure and cardiovascular outcomes]. / Uminio sirdies nepakankamumo sasajos su sirdies ir kraujagysliu sistemos ligu baigtimis.

UNLABELLED: The aim of the study was to determine associations of acute coronary syndrome and acute heart failure with mortality from cardiovascular causes during hospitalization and mortality from cardiovascular causes and chronic heart failure during one-year period. MATERIAL AND METHODS: A total of 1554 consecutive patients with discharge diagnosis of acute coronary syndrome, treated at the Clinic of Cardiology, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005, were prospectively enrolled into the study. For the assessment of patients' status, data from the Cardiac Center Registry database were used. Patients were followed up for one year from admission to hospital. RESULTS: Acute heart failure was diagnosed in 32.3% of patients during hospitalization, and chronic heart failure was diagnosed in 17% during a one-year follow-up period. Myocardial revascularization was performed in 70.8% of patients with coronary artery stenosis of ≥70%. After one year, chronic heart failure was documented in 1039 patients, and it was almost three times more frequent in patients who had acute heart failure at diagnosis of acute coronary syndrome than in patients without acute coronary syndrome during hospitalization (31.4% vs. 11.6%; P<0.05). Death from cardiovascular causes occurred more frequently in patients with acute heart failure than without it during both in-hospital and out-of-hospital periods (11.5% vs. 1.9%, P<0.001; 7.7% vs. 2.3%, P<0.001). CONCLUSION: In the presence of acute coronary syndrome, diagnosed acute heart failure significantly increases the frequency of chronic heart failure during one-year period and mortality rate from cardiovascular diseases during hospitalization and one-year period.

The prevalence of the metabolic syndrome components and their combinations in men and women with acute ischemic syndromes.

During the last decade, it has been shown that the metabolic syndrome and its different components--arterial hypertension (AH), abdominal obesity (AO), diabetes mellitus (DM), atherogenic hypertriglyceridemia (HTG), and/or low concentration of high-density lipoprotein cholesterol (HDL-C))--increase the risk of cardiovascular diseases. There is increasing evidence that the incidence of the metabolic syndrome and the distribution of its components in combinations in the general male and female population differ. The aim of our study was to determine the incidence of the metabolic syndrome in men and women with acute ischemic syndromes and to evaluate the distribution of the metabolic syndrome component combinations in the presence of the metabolic syndrome. Contingent and methods. The study included 2756 patients (1670 males and 1086 females) with acute ischemic syndromes (1997 with myocardial infarction and 759 with unstable angina pectoris), in whom all five components of the metabolic syndrome were assessed. Women were significantly older than men (68.1+/-9.5 vs. 60.2+/-11.8 years, P<0.001). The metabolic syndrome was found (according to modified NCEP III) in 1641 (59.5%) patients (in 70.2% of females and in 52.6% of males, P<0.001). The most common components in both men and women were AH and AO (94.0% vs. 95.9% and 86.4% vs. 84.5%, respectively). HTG was significantly more common in men than in women (80.0% vs. 73.0%, P<0.001), while decreased HDL-C concentration was more common in women (82.8% and 59.2%, P<0.001). The DM component, detected in more than one-third of patients with acute ischemic syndromes, was significantly more common in women than in men (39.2% vs. 33.1%, P<0.05). Combinations of three components were significantly more common in men than in women, while combinations of four-five components were more common in women (55.6% vs. 41.4%, P<0.001; and 58.6% vs. 44.4%, P<0.01). The most common combination of three components in men was AH+AO+HTG and in women--AH+AO+low HDL-C; the most common combination of four components in both men and women was AH+AO+HTG+low HDL-C. CONCLUSION. In the metabolic syndrome, the differences between the components of atherogenic dyslipidemia in patients with acute ischemic syndromes were related to the patients' gender: men significantly more frequently had increased TG concentration and women--decreased HDL-C concentration; this is the problem to be addressed in further studies of dyslipidemia.

[Prevalence of metabolic syndrome components in patients with acute coronary syndromes]. / Metabolinio sindromo komponentu daznis tarp susirgusiuju uminiais iseminiais sindromais.

OBJECTIVE: Many studies report that the components of the metabolic syndrome--arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia--are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes. METHODS AND RESULTS: The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3+/-11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (> or =6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components. CONCLUSION: More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome.

Prognostication of late left ventricular systolic dysfunction in patients with acute coronary syndrome during the acute period.

The aim of the study was to create the model of the combination of clinical and echocardiographic determinants during the acute period of acute coronary syndromes for the prognostication of the risk for left ventricular dysfunction after one year. We examined 565 patients with first-time acute coronary syndrome with no recurrence during one-year period. The studied group consisted of 496 patients, and the examined group--of 69 patients. All patients with acute coronary syndrome within the first three days underwent the evaluation of demographic, anamnesis, clinical indicators, risk factors for ischemic heart disease, ECG, and echocardiographic findings for the prognostication of the risk of left ventricular dysfunction after one year. Multiple logistic regression analysis was applied for the identification of independent determinants for the prognostication of left ventricular dysfunction, and three risk groups were identified. The prognostic informative value of the model was verified by comparing the incidence of left ventricular systolic dysfunction in risk groups after one year between the studied and the control groups. RESULTS. After one year, left ventricular systolic dysfunction (left ventricular ejection fraction <40%) in the presence of acute coronary syndrome remained in more than half (65.3%) of patients and returned to normal (left ventricular ejection fraction > or =40%) in one-third of patients (34.7%). Left ventricular systolic function that was normal during the acute period of coronary syndrome remained such in the majority (80.9%) of patients after one year, whereas one-fifth (19.1%) of patients developed left ventricular systolic dysfunction. The mathematical model for the prognostication of systolic dysfunction after one year was composed of the determinants of acute coronary syndrome: left ventricular ejection fraction <40%, anterior localization of Q-wave myocardial infarction, Killip class 3-4, left ventricular pseudo-normal or restrictive diastolic function, and frequent ventricular extrasystoles. The application of our model in the prognostication of late left ventricular systolic dysfunction during the acute period of coronary syndrome showed that the model was reliable, since after one year, the prognosticated left ventricular systolic dysfunction was determined in the majority (84.3%) of patients. The designed mathematical model is simple and is based on standard clinical and echocardiographic findings, and the scoring system allows for the prognostication of the risk for late left ventricular systolic dysfunction in any individual patient. The prognostication of the risk for late left ventricular systolic dysfunction during the acute period of coronary syndrome may help in the planning of treatment and outpatient care in patients with acute coronary syndrome.

[Secondary prevention of ischemic heart disease: pharmacological treatment after myocardial infarction according to follow-up protocol]. / Antrine isemines sirdies ligos profilaktika persirgus miokardo infarktu (medikamentinio gydymo ivertinimas remiantis anketines apklausos duomenimis).

UNLABELLED: The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction. MATERIAL AND METHODS: We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8+/-3.2 months after myocardial infarction were collected by letter with questionnaire. RESULTS: Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely--two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Beta-adrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6-10.3%). CONCLUSIONS: These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction.

[Admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus]. / Susirgusiuju miokardo infarktu, be cukrinio diabeto anamnezeje, hiperglikemijos daznis hospitalizavus ir israsant is stacionaro.

UNLABELLED: The objective of this study was to determine frequency of admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus. METHODS AND RESULTS: Data on 1522 patients with acute myocardial infarction and no previous history of diabetes mellitus were analyzed. Before discharge from hospital, standardized oral glucose tolerance test was performed in 197 patients with admission hyperglycemia. RESULTS: Admission hyperglycemia (> or =6.1 mmol/L) was determined in half of the patients with acute myocardial infarction: glucose concentration of 6.1-6.99 mmol/L was in 21.5% and > or =7.0 mmol/L in 30.1% of the patients. By using glucose tolerance test, normal glucose metabolism was noted in 57.9% of the patients with admission hyperglycemia; abnormal glucose tolerance was diagnosed newly in more than one-third and glucose concentration of > or =11.1 mmol/L in 10.1% of the patients. CONCLUSIONS: Abnormal glucose tolerance is a frequent feature in nondiabetic patients with admission hyperglycemia during acute myocardial infarction, and glucose tolerance test should be considered in all patients with ischemic heart disease for early modification of this risk factor.

[Evaluation of clinical parameters and myocardial perfusion scintigraphy findings in patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test]. / Klinikiniu rodmenu ir miokardo perfuzijos sutrikimu ivertinimas pacientams, kuriems itariama isemine sirdies liga, pakitusi ramybes elektrokardiograma ir neinformatyvus veloergometrijos tyrimas.

UNLABELLED: The aim of this work was to estimate the impact of clinical variables on predicting stress myocardial perfusion abnormalities in patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test. MATERIAL AND METHODS: The clinical variables and stress myocardial perfusion data were analyzed in 370 patients (157 males and 213 females) with suspected coronary artery disease and abnormal resting electrocardiogram. All patients underwent (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy following a one-day protocol (stress-rest). The bicycle exercise test was considered noninterpretable when the age-predicted peak heart rate was not achieved, and ischemic signs were not detected. RESULTS: One hundred sixty (43.2%) patients had noninterpretable bicycle exercise test. Pathological stress myocardial perfusion defects (reversible and fixed) were more often present in patients with noninterpretable than in patients with informative exercise test (63.1 and 50.0%, respectively, p<0.01). Univariate analysis showed that reversible perfusion defects were more frequent in men than in women (p<0.00001, odds ratio 9.6), in patients with pre-existing left bundle-branch block (p<0.02, odds ratio 3.4), and in cases when sufficient working capacity (> or =150 W) was achieved (p<0.05, odds ratio 2.1). CONCLUSION: The myocardial perfusion defects were registered in 63.1% of patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test. The probability of reversible perfusion defects was higher in male patients, in patients with pre-existing left bundle-branch block and with sufficient working capacity (> or =150 W).

[Prevalence of cardiovascular risk factors in coronary heart disease patients with different low-density lipoprotein phenotypes]. / Serganciuju isemine sirdies liga rizikos veiksniu daznumas esant skirtingam mazo tankio lipoproteinu fenotipui.

UNLABELLED: Low-density lipoprotein (LDL) heterogeneity is now well recognized as an important factor reflecting differences in lipoprotein composition, size, metabolism and genetic influences. There is an abundant evidence of data supporting the clinical importance of small, dense LDL particles in the development of coronary heart disease. The aim of the study was to determine the prevalence of LDL phenotypes A and B in coronary artery disease patients and to assess the incidence of cardiovascular risk factors in groups with different phenotype. MATERIAL AND METHODS: Demographic, anamnestic and clinical data as well as complete lipid profile--total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides--were collected on 1,220 patients (63.7% male and 36.3% female, mean age 61.3+/-11.0 years) with coronary artery disease. Triglycerides/HDL cholesterol ratio was calculated. By value of triglycerides/HDL cholesterol ratio, proposed V. Hanak and authors, the patients were identified as having LDL phenotype A when the ratio was < or =1.64 (a value of 3.8 as expressed in milligrams per deciliter) and phenotype B when the ratio was >1.64. RESULTS: LDL profile in 60.5% of patients was identified as phenotype A and in 39.5%--as phenotype B. The incidence of coronary heart disease risk factors was higher in phenotype B patients as compared to phenotype A subjects (hypertension - 85.1% vs. 75.2%, p<0.001, diabetes mellitus--13.9% vs. 5.5%, p<0.001, obesity--46.7% vs. 28.0%, p<0.001, reduced physical activity--64.5% vs. 57.0%, p<0.001). Metabolic syndrome was present in 85.1% of phenotype B patients, while this cluster of metabolic disorders was detected only in 36.8% of phenotype A subjects. The incidence of myocardial infarction, presence of multiple high-grade coronary lesions were also higher in phenotype B patients as compared to their counterparts with phenotype A (22.2% vs. 17.2%, p<0.05 and 13.7% vs. 8.7%, p<0.05). CONCLUSION: LDL phenotype B was determined in 39.5% of coronary heart disease patients. Atherogenic LDL subclass pattern B correlated with higher incidence of major coronary heart disease risk factors.

Informative value of clinical markers for the risk of cardiovascular death in postinfarction chronic heart failure.

UNLABELLED: Symptomatic chronic heart failure (CHF) in patients with previous myocardial infarction results in a high risk of death. The aim of the study was to determine the informative value of different clinical markers and their combinations for cardiovascular death risk evaluation in case of CHF after Q-wave myocardial infarction (MI). METHODS: Two hundred and twenty-four patients with congestive heart failure NYHA class II-IV after Q-wave MI were followed-up for five years (median 2.6 +/- 2.0 years). The probability of cardiovascular death was evaluated using Kaplan-Meier curves, the impact of clinical variables on the risk of death, and adjusted risk of death were evaluated using Cox proportional regression method, and the total risk score of death was determined using the multivariate regression method. RESULTS: The probability of cardiovascular death within the first year was 21%, within two years 40%, within three years 55%, within four years 61%, and within five years 65%. According to the risk of death, the independent predictors were allotted a risk score which was determined for all patients and had shown a strong association with 5-year cardiovascular mortality. Patients with a risk score of 9, versus those with a score of 0, were found to have a 15-fold increase in cardiovascular mortality rate. CONCLUSION: The probability of cumulative cardiovascular mortality within five years in case of a symptomatic CHF after Q-wave MI was 65%. In the presence of risk factor combinations, the probability of death within three years reached 98%.

[Cardiac events and 5-year survival after acute coronary syndromes]. / Kardialiniai ivykiai ir isgyvenimas penkerius metus po persirgtu uminiu iseminiu sindromu.

OBJECTIVE: To evaluate the incidence of cardiac events and survival in patients with first acute coronary syndromes during 5-year period. METHODS AND RESULTS: Data on 732 patients admitted with first acute coronary syndrome were collected in a database. During hospitalization period 45.4% of the patients received reperfusion therapy. During follow-up period (4.49+/-2.1 years) 215 (29.4%) patients had cardiac events: 15.3%--myocardial revascularization, 8.1%--repeated myocardial infarction, 11.5%--cardiovascular deaths. The highest (5%) mortality rate was during first year, whereas during the following four years--1.5% annually. Kaplan-Meier analysis for survival free of cardiovascular death revealed that mortality rates were higher among patients who were > or =65 years old (long-rank test, p=0.02); had heart failure at admission (p=0.003), left ventricular ejection fraction <40% (p=0.04), significance diastolic dysfunction (p=0.035), III-IV degrees mitral regurgitation (p=0.00006); did not received reperfusion therapy (p=0.007). CONCLUSION: The analysis of this long-term follow-up data shows that the patients with acute coronary syndromes carry a high risk of death and need better treatment strategies to reduce risk.

[Late results of minimally invasive operations of myocardial revascularization in patients with acute coronary syndrome]. / Minimalios apimties miokardo revaskulizacijos be dirbtines kraujo apytakos, atliktos uminiu iseminiu sindromu laikotarpiu, itaka velesnems iseminems pasekmems.

UNLABELLED: The aim of the study was to compare late results of the minimally invasive operations of myocardial revascularization and conservative treatment in patients with acute ischemic syndrome. MATERIAL AND METHODS: Demographic, clinical and echocardiographic data was collected on patients with acute ischemic syndrome; data of 109 patients treated conservatively and data of 26 patients, who underwent minimal invasive operation of myocardial revascularization during acute phase of ischemic syndrome, were compared and ischemic consequences after one-year follow up period were determined in both groups. RESULTS: The patients of both groups did not differ significantly according to the most clinical characteristics. One third of the patients in the surgery group had previous myocardial infarction, also they had higher rate of paroxysmal atrial fibrillation (26.9% vs 6.4%) and acute left ventricular failure (73.1% vs 44.0%) than the patients without operation. During one-year follow up period there were no cases of lethal events or myocardial infarction in the surgical group, however 37.5% of them had mild angina pectoris. At that time lethal outcome was observed in 6.1%, myocardial infarction in 3.5% and mild-severe angina pectoris in 68.8% of patients. CONCLUSION: The functional status of the patients significantly improved during one-year period after minimally invasive operation of myocardial revascularization compared to the patients treated conservatively.

Lethal outcomes in patients with symptomatic heart failure developed after Q-wave myocardial infarction.

The article analyses clinical characteristics and mortality of patients with symptomatic chronic heart failure following Q-wave myocardial infarction. During the study 224 patients (mean age 64.1+/-9.7) with symptomatic chronic heart failure and left ventricular ejection fraction <40% were followed-up for 1-5 years (on the average, 2.6+/-2.0 years). The majority of the studied patients had had anterior or anterior-lower Q-wave myocardial infarction (61.6% and 25.9%, respectively) and an identified Canadian function class II-IV angina pectoris (74.6%), and one-fifth of the patients (19.6%) had unstable angina pectoris. All patients were diagnosed with chronic heart failure New York Heart Association function class II-IV, the majority of patients had disturbances in cardiac rhythm and conduction, almost a half of them (46.0%) had left ventricular aneurysm, 92.8% of patients were diagnosed with marked changes in left ventricular geometry, 84.4% of patients had II-IV degrees mitral regurgitation, a half of the patients had significant left ventricular diastolic dysfunction, and 6.3% of patients had previously experienced thromboembolic complications. During the follow-up period 132 patients died. The comparison of the characteristics of patients who survived with those of patients who died showed that the deceased patients were statistically significantly older compared to survivors; in addition to that, marked stenoses of three coronary arteries, severe chronic heart failure, ejection fraction < or =20%, ventricular extrasystoles, and sinal tachycardia were more common in the former group, and patients who died less frequently were overweight and less frequently used beta adrenoblockers. The evaluation of Kaplan-Meier curves showed that total mortality resulting from the development of chronic heart failure symptoms and indications of chronic heart failure during the 1st year was 21.0%, during the 2nd year -40%, during the 3rd year -55.0%, during the 4th year -61.0%, and during the 5th year -65.0% the highest mortality was observed when left ventricular ejection fraction < or =20%, and age >75. The development of severe chronic heart failure resulted, on the average, after 1.5+/-1.1 years. It is obvious that symptomatic chronic heart failure caused by ischemic cardiomyopathy and marked left ventricular systolic dysfunction following Q-wave myocardial infarction is a rapidly progressing process conditioning high risk of lethal outcome within the period of several years.

[Ischemic heart disease mortality risk in patients with diabetes mellitus]. / Isemines sirdies ligos letalios baigties tikimybes sergant cukriniu diabetu.

AIM: The significance of clinical characteristics during acute phase of coronary syndrome for hospital prognosis is well established. However their prognostic ability and impact on defining risk of lethal outcome during one-year period after acute coronary syndrome in pts with diabetes mellitus is not clarified. METHODS: In a prospective one-year study 699 pts with first acute coronary syndrome were studied: 61 with diabetes mellitus and 638 without diabetes mellitus. We have analyzed their demographic characteristics, risk factors of ischemic heart disease, clinical, echocardiographic, angiographic data. During one year follow up period there were 61 cases of cardiac death. RESULTS: Univariate analysis showed, that pts with diabetes mellitus vs pts without diabetes mellitus more often were female, aged >65 years, had arterial hypertension, obesity and sinusal tachycardia, severe acute left ventricular failure, three - vessel coronary disease, episodes of paroxysmal atrial flutter during acute phase of acute coronary syndrome (p<0.05). Multivariate logistic regression analysis showed that these variables remained independent predictors for lethal outcome and had OR from 1.6 to 9.5 in pts without diabetes mellitus. The presence of diabetes mellitus increased the value of OR of these variables 1.5-2.5 fold and this followed to the further stratification of pts. The value > and =14 of general risk score in multivariate model indicated the high risk for lethal outcome during one-year period. Almost half of pts (48.3%) with diabetes mellitus had the high risk, a 36.5 percent of them died during follow up. The sensitivity of risk score in predicting mortality was 37.3 percent in high risk group and 58.8 percent in low risk group, specificity--96.7 percent and 82.7 percent respectively. CONCLUSION: These results imply that the presence of diabetes mellitus in pts with acute coronary syndrome increases risk for lethal outcome two-fold during one-year period after acute coronary syndrome.