Investigation of Acoustic Properties of Different Types of Low-Noise Road Surfacers under In Situ and Laboratory Conditions.

Current literature on the performance characteristics of road surfaces is primarily focused on evenness, roughness and technical durability. However, other important surface properties require analysis, including noisiness, which is an important feature of the environmental impact of vehicular traffic around roads. This can be studied using various methods by which road noise phenomena are investigated. The method used to measure the noise performance of road surfaces herein is the Statistical Pass-By (SPB) method, as described in ISO 11819-1:1997. The impedance tube method was used for sound absorption testing, as described in ISO 13472-2:2010. These tests were performed under a variety of conditions: in situ and in laboratory. The existence of relationships between them can be helpful in selecting surfaces for noise reduction. Preliminary surface noise tests can be performed in the laboratory with samples consisting of various compounds. This is less expensive and faster than doing so on purpose-built surfaces. The paper presents study results for sound absorption coefficients of various types of low-noise surfaces in in situ conditions (on an experimental section and on operated road sections) and in the laboratory setting. The results of the tests performed on the operational sections were compared to the results of the surface impact on road noise using the SPB method. The correlations between the test results help confirm the feasibility of road surface pre-testing in the laboratory and the relation to tests performed using the SPB method under typical operating conditions.

The usefulness of telemedicine devices in patients with severe heart failure with an implanted cardiac resynchronization therapy system during two years of observation.

BACKGROUND: Heart failure (HF) remains a disease with a poor prognosis. Telemonitoring is a medical service aimed at remote monitoring of patients. AIM: The study aimed to identify the clinical relevance of non-invasive telemonitoring devices in HF patients. METHODS: Sixty patients aged 66.1 (11) years, with left ventricular ejection fraction (LVEF) 26.3 (6.8)% underwent cardiac resynchronization therapy (CRT) implantation. They were randomly allocated to the control (standard medical care) or study (standard medical care + telemonitoring device) groups. During the follow-up (24 months), the patients in the study group provided body mass and blood pressure, along with electrocardiogram on a daily basis. The data were transferred to themonitoring center and consulted with a cardiologist. Transthoracic echocardiography and a 6-minute walk test were performed before and 24 months after CRT implantation. RESULTS: During the two-year observation, the composite endpoint (death or HF hospitalization) occurred in 21 patients, more often in the control group (46.8% vs. 21.4%; P = 0.026). Inunivariate analysis: the use of telemetry (hazard ratio [HR], 0.2; 95% confidence interval [CI], 0.07-0.7; P=0.004), thepresence of coronary heart disease (HR, 41.4; 95% CI, 3.1-567.7; P=0.005), hypertension (HR, 0.24; 95% CI, 0.07-0.90; P = 0.035), and patient's body mass (HR, 0.36; 95% CI, 0.14-0.92; P = 0.03) were related to the occurrence of the composite endpoint. CONCLUSIONS: The use of a telemonitoring device in CRT recipients improved theprognosis in2-year observation and contributed to the reduction of HF hospitalization.

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion.

INTRODUCTION: Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI). MATERIAL AND METHODS: Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up. RESULTS: At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. -11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR- group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (-15.58 ±8.9% vs. -25.53 ±8.8%, p < 0.001; -15.02 ±5.6 vs. -19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (-8.7 ±5.8% vs. -13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR- group. According to ROC analysis, circumferential apical strain > -15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI. CONCLUSIONS: Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients' follow-up.

Prediction of infarct size by speckle tracking echocardiography in patients with anterior myocardial infarction.

BACKGROUND: Speckle tracking echocardiography (STE) is based on tracing of pixel groups in grayness scale for the quantitative measurement of myocardium strain and myocardium strain rate. Recent data suggest that evaluation of STE could be a tool for myocardial function assessment similar to MRI. AIM: To assess the predictive value of STE for the evaluation of infarct size in patients with anterior ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 39 patients with the first anterior wall STEMI (mean age 59±10 years, 29 men). All patients were treated with a primary percutaneous coronary intervention, and the time from the symptom onset to reperfusion was 298±195 min. Left ventricular ejection fraction assessed in three-dimensional echocardiography was 47±9%. On the day of discharge, STE was performed to determine the average global value of peak longitudinal strain (GLS) of 16 myocardial segments. The average value of the peak longitudinal strain for nine segments supplied by the left anterior descending artery anterior wall global longitudinal strain was assessed separately. Infarct size was assessed 3 months after STEMI by MRI using late gadolinium enhancement, and a large infarct was defined as at least 20% left ventricle myocardium covered by the scar. RESULTS: According to the results of MRI, we defined two groups: 22 patients with a large infarct (≥20%, group A) and 17 patients with a small infarct (<20%, group B). There were no differences between both groups in the demographics and cardiovascular risk factors. There was a significant correlation between GLS and the degree of myocardium injury assessed by MRI (r=0.62, P=0.001). The correlation was higher for anterior wall global longitudinal strain (r=0.68, P=0.001). With the receiver operating characteristic curve, the cut-off point for GLS was calculated (-12.3), which defined a large infarct with 82% sensitivity and 87% specificity (area under the curve=83). For segments supplied by the left anterior descending artery, the cut-off value for the prediction of a large infarct was -11.5 (sensitivity 90%, specificity 73%, area under the curve=84). CONCLUSION: STE seems to be a very promising tool in the prediction of infarct size in patients with anterior STEMI.

Dynamicity of early and late phases of repolarization in patients with remote anterior myocardial infarction: the interlead differences.

BACKGROUND: Repolarization dynamicity (QT/RR) is supposed to be a prognostic marker in post-MI patients. However, data on the relationships between early and late phases of QT and RR intervals (QT peak/RR and T peak-T end/RR) are insufficient, and which ECG lead should be used for the analysis is unclear. We analyzed repolarization dynamicity in patients after anterior MI with and without VT/VF history using two leads of Holter recordings- modified V(5) and V(3) . The daytime and nighttime periods were also analyzed. METHODS: Cohort of 88 patients after anterior MI (>6 months) consisted of 43 patients without VT/VF (33 males; 59 ± 12 years; LVEF: 41 ± 7%; NoVT/VF), and 45 patients with VT/VF history- ICD implanted as secondary prevention (40 males; 64 ± 10 years; LVEF: 32 ± 8%; VT/VF). QT/RR, QT peak/RR and T peak-T end/RR were calculated from 24-hour ECG for the entire recording, daytime and nighttime periods, from V(5) and V(3) leads, respectively. RESULTS: VT/VF patients had lower LVEF (P = 0.001). There were no differences in age and gender. VT/VF group had steeper QT/RR, QT peak/RR, and T peak-T end/RR in V(5) : 0.233 ± 0.04 versus 0.150 ± 0.05, P = 0.0001, 0.181 ± 0.04 versus 0.120 ± 0.04, P = 0.0001, 0.052 ± 0.02 versus 0.030 ± 0.02, P = 0.0001, and in V(3) : 0.201 ± 0.04 versus 0.149 ± 0.05, P = 0.0001, 0.159 ± 0.03 versus 0.118 ± 0.04, P = 0.0001, and 0.042 ± 0.02 versus 0.031 ± 0.02, P = 0.004; respectively. VT/VF patients had higher indices in V(5) than in V(3) lead (P = 0.001). QT/RR and QT peak/RR were steeper at daytime period in both leads. It was not found for T peak-T end/RR. CONCLUSIONS: Patients with VT/VF history are characterized by steeper relationships between repolarization duration and RR intervals. These findings are more evident in modified V(5) lead.

Value of speckle-tracking echocardiography for prediction of left ventricular remodeling in patients with ST-elevation myocardial infarction treated by primary percutaneous intervention.

BACKGROUND: Left ventricular remodeling (LVr) is still common after ST-segment elevation myocardial infarction (STEMI). Early predictors of remodeling are being investigated. The aims of this study were to evaluate the prognostic value of speckle-tracking echocardiography for the prediction of LVr 3 months after primary percutaneous coronary intervention in patients with STEMI and to analyze the relationship between values of peak longitudinal strain of particular LV segments and relative changes of their subvolumes. METHODS: Patients with first STEMI were enrolled. Baseline enzymes were collected, and electrocardiography and echocardiography (transthoracic echocardiography, speckle-tracking echocardiography, and three-dimensional studies) were preformed. Three months after myocardial infarction, two-dimensional and three-dimensional ultrasonographic studies were done. RESULTS: Sixty-six patients were divided into two groups: 44 patients without LVr and 22 patients with LVr. Among 31 patients with anterior wall STEMI, the rate of LVr was 42%. On the basis of assessments of baseline and follow-up myocardial wall contractility, 1,041 segments were analyzed. All segments were divided into normal (n = 842), reversibly dysfunctional (n = 68), and irreversibly dysfunctional (n = 131). Receiver operating characteristic curve analysis showed that global longitudinal strain predicted LVr with an optimal cutoff value of -12.5% (area under the curve, 0.77). In multivariate analysis, diabetes mellitus (odds ratio, 4.61; 95% confidence interval, 1.19-18.02) and global longitudinal strain (odds ratio, 1.19; 95% confidence interval, 1.04-1.37) were determinants of LVr. Positive correlations were found between peak longitudinal strain and changes in subvolumes for all segments (R = 0.11, P = .005) and for those irreversibly dysfunctional (R = 0.22, P = .04). CONCLUSIONS: In patients with STEMI treated by primary percutaneous coronary intervention, the frequency of LVr during 3-month follow-up was high and mainly affected the population with anterior wall myocardial infarction. The results of this study show the clinical value of global longitudinal strain measured by speckle-tracking echocardiography in the prediction of LVr. A moderate correlation was found between the value of peak longitudinal strain and changes in subvolumes attributed to irreversibly dysfunctional segments.

Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI: use of quantitative myocardial contrast echocardiography.

OBJECTIVES: We sought to determine the frequency of left ventricular remodeling in the 6-month follow-up after anterior ST elevation myocardial infarction and the value of quantitative parameters of perfusion contrast echocardiography for prognosis of left ventricular remodeling against other established risk. METHODS: A total of 60 patients with anterior ST elevation myocardial infarction treated by primary percutaneous intervention were examined. In 28 patients, thromboaspiration was performed before stent implantation with Driver catheter. Before and after successful angioplasty, perfusion in myocardial blush grade (MBG) scale was assessed. Various electrocardiogram parameters were analyzed. Resting perfusion with myocardial contrast echocardiography was performed. RESULTS: Logistic regression has permitted one to conclude that higher value of MBG, higher left ventricular ejection fraction at discharge, and higher value of parameter A at quantitative echocardiography in dysfunctional segments were prognostic for lack of remodeling over 6 months. The receiver operating characteristics curves for parameters of quantitative perfusion echocardiography (A, ß, A×ß) allowed us to conclude that value A>1.96 dB, value ß>0.155 s, and value A×ß>0.57 dB/s are optimal cut-off points prognostic for remodeling. Area under the curve was 0.8 for A and 0.85 for ß. CONCLUSION: The best predictors of remodeling in 6 months' observation have appeared to be lower left ventricular ejection fraction at discharge, poorer perfusion assessed angiographically (MBG scale), and the rate of signal intensity increase reflecting the mean bubble velocity of the myocardium by contrast as assessed by contrast echocardiography. Quantitative perfusion angiography independently has high predictive value for the development of remodeling in long-term follow-up.

Heart rate turbulence in postinfarction patients with history of malignant ventricular arrhythmias.

UNLABELLED: In the study, there has been retrospectively analyzed heart rate turbulence in postinfarction patients. The cohort of 158 patients consisted of 94 patients with documented ventricular tachycardia and/or ventricular fibrillation (VT/VF) and 64 patients without history of VT/VF. Turbulence onset and slope were calculated from Holter recordings, and left ventricle ejection fraction (LVEF) ≤35% was regarded as severe left ventricle dysfunction. Study groups were similar in age and sex. Left ventricle ejection fraction was lower in the VT/VF group (P < .005). Patients with VT/VF had higher turbulence onset (-0.22% ± 1% vs -0.8% ± 2%; P = .005) and lower turbulence slope (2.6 ± 1.9 vs 4.1 ± 3.5 milliseconds per RR interval; P = .01). These trends were observed in patients with LVEF >35% but not in subjects with LVEF ≤35%. Diabetes mellitus, previous coronary artery bypass graft, and amiodarone therapy have diminished the intergroup differences significantly. CONCLUSIONS: Heart rate turbulence is diminished in postinfarction patients with a history of malignant ventricular arrhythmias. It seems to separate subjects at arrhythmic risk among patients with relatively preserved left ventricle function, but it is diminished in patients with previous coronary artery bypass graft, diabetes, and amiodarone therapy.

Late phase of repolarization (TpeakTend) as a prognostic marker of left ventricle remodeling in patients with anterior myocardial infarction treated with primary coronary intervention.

BACKGROUND: Left ventricle remodeling (LVR) is regarded as a marker of unfavorable outcome in patients following acute myocardial infarction (AMI). Repolarization, especially its late part (TpeakTend), is strongly related to local myocardial attributes. We assessed prospectively in this study if repolarization duration (measured from one hour of nighttime) might predict LVR occurrence in patients with anterior AMI treated with primary percutaneous coronary intervention (PCI). METHODS: The study population consisted of 111 patients with first anterior AMI (82 males, age 58 +/- 11 years, LVEF 41 +/- 7%) treated with the primary PCI of left anterior descending coronary artery. LVR, defined as left ventricle end-diastolic volume increase by > 20% during six months follow-up, occurred in 35 patients (31 males, age 56 +/- 10 years, LVEF 37 +/- 7%, LVR+), while the other 76 subjects were free of LVR (51 males, age 58 +/- 10 years, LVEF 43 +/- 7%, LVR-). Holter recordings were performed in the fifth day of AMI. Repolarization parameters: QT, QTpeak and TpeakTend were assessed from one hour of nighttime Holter recording (between 1-4 a.m.). RESULTS: LVR occurred more frequently in males (p = 0.02). LVEF was lower in LVR+ patients (p = 0.001). QTc was similar: 441 +/- 29 ms vs 434 +/- 25 ms, p = 0.37 for LVR+ vs LVR-. Patients with LVR had shorter QTpeakc (333 +/- 34 ms vs 345 +/- 25 ms, p = 0.03) and remarkably longer TpeakTendc (108 +/- 15 ms vs 89 +/- 17 ms, p = 0.0001). Receiver operating characteristics analysis revealed that the best cut-off value for LVR prediction was 103 ms--sensitivity: 65.7%, specificity: 81.6%, positive predictive value: 62%, negative predictive value: 83.8%. CONCLUSIONS: The greater transmural heterogeneity of the repolarization processes described by TpeakTend interval measured at discharge after AMI seems to be a prognostic marker of left ventricle remodeling occurrence during six months follow-up in patients with acute anterior infarction.

Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction.

BACKGROUND: Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. AIM: To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). METHODS: One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. RESULTS: Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. CONCLUSIONS: Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.

Microvascular damage prevention with thrombaspiration during primary percutaneous intervention in acute myocardial infarction.

BACKGROUND: Despite rapid and complete recanalization of infarct-related artery with percutaneous coronary intervention, microvascular integrity is not often preserved. Several mechanical devices have been proposed to prevent distal embolization, but the impact of these devices on myocardial perfusion remains controversial. AIM: The aim of our study was to assess microvascular damage reduction with quantitative myocardial contrast perfusion echocardiography among patients with the first anterior acute myocardial infarction treated with thromboaspiration during percutaneous coronary intervention. METHODS: Forty-two patients (57.4+/-10 years, 74% males) with first anterior acute myocardial infarction were randomized 1 : 1 to intracoronary thromboaspiration followed by stenting, or to a conventional strategy of stenting alone. Echocardiogram and quantitative myocardial contrast echocardiography were performed 7 days and 1 month later, respectively. Parameter A (reflecting myocardial blood volume), beta (reflecting velocity, myocardial blood flow), and product of A and beta as indicator of myocardial blood flow were analyzed. For each patient mean value of A, beta, and A x beta from all dysfunctional segments was calculated. RESULTS: The study population was divided into two groups: thromboaspiration (group I, 19 patients) and stenting alone (group II, 23 patients). No difference was observed between the both groups in demographic, clinical, echocardiographic, and angiographic data. Parameter A and A x beta were significantly higher in group I than in group II: 8.58+/-2.54 versus 5.29+/-3.18 dB (P<0.001) and 5.29+/-3.73 versus 2.78+/-3.03 dB/s (P<0.001). Multivariate step-down regression analysis revealed that only thromboaspiration before stenting and lower maximum troponin I have been associated with viability preservation in infarcted region. CONCLUSION: Thromboaspiration before stenting in patients with the first anterior myocardial infarction improves myocardial perfusion at the tissue level assessed by quantitative myocardial contrast echocardiography.

Impact of left ventricular remodeling on ventricular repolarization and heart rate variability in patients after myocardial infarction treated with primary PCI: prospective 6 months follow-up.

BACKGROUND: The relation between postinfarction left ventricle remodeling (LVR), autonomic nervous system and repolarization process is unclear. Purpose of the study was to assess the influence of LVR on the early (QTpeak) and late (TpeakTend) repolarization periods in patients after myocardial infarction (MI) treated with primary PCI. The day-to-night differences of repolarization parameters and the relation between QT and heart rate variability (HRV) indices, as well left ventricle function were also assessed. METHODS: The study cohort of 104 pts was examined 6 months after acute MI. HRV and QT indices (corrected to the heart rate) were obtained from the entire 24-hour Holter recording, daytime and nighttime periods. RESULTS: LVR was found in 33 patients (31.7%). The study groups (LVR+ vs LVR-) did not differ in age, the extent of coronary artery lesions and treatment. Left ventricle ejection fraction (LVEF) was lower (38%+/- 11% vs 55%+/- 11%, P < 0.001), both QTc (443 +/- 26 ms vs 420 +/- 20 ms, P < 0.001) and TpeakTendc (98 +/- 11 ms vs 84 +/- 12 ms, P < 0.005) were longer in LVR + patients, with no differences for QTpeakc. Trends toward lower values of time-domain (SDRR, rMSSD) HRV parameters were found in LVR+ pts. Day-to-night difference was observed only for SDRR, more marked in LVR-group. Remarkable relations between delta LVEF (6 months minus baseline), delta LVEDV and TpeakTendc were found, with no such relationships for QTpeakc. CONCLUSIONS: The patients with LVR have longer repolarization time, especially the late phase-TpeakTend, which represents transmural dispersion of repolarization. Its prolongation seems to be related to local attributes of myocardium and global function of the left ventricle but unrelated to the autonomic nervous influences. Remodeling with moderate LV systolic dysfunction is associated with insignificant decrease in HRV indices and preserved circadian variability.

QT/RR relationship in patients after remote anterior myocardial infarction with left ventricular dysfunction and different types of ventricular arrhythmias.

BACKGROUND: QT/RR relationship was found to be both rate-dependent and rate-independent, what suggests the influence of autonomic drive and other not-autonomic related factors on it. The steeper QT/RR slope in patients after acute myocardial infarction (MI) was described, but the relationship to ventricular arrhythmias is unknown. The purpose of this study was to calculate differences in QT/RR relationship in patients after remote anterior MI with left ventricular dysfunction and different types of ventricular arrhythmias. METHODS: The cohort of 95 patients (age: 63 +/- 11 years, LVEF: 35 +/- 9%) with previous anterior MI (mean 1.1 years) was divided into two well-matched groups-50 patients without episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) (NoVT/VF: 39 males, 64 +/- 12 years, LVEF 37 +/- 8%) and 45 patients with VT and/or VF (all with ICD implanted) (VT/VF: 35 males, 62 +/- 10 years, LVEF 34 +/- 10%). No true antiarrhythmics were used. QT/RR slope was calculated from 24-hour Holter ECG for the entire recording (E), daytime (D) and nighttime (N) periods. RESULTS: Groups did not differ in basic clinical data (age, LVEF, treatment). QT/RR slopes were steeper in VT/VF than in NoVT/VF group in all analyzed periods: E - 0.195 +/- 0.03 versus 0.15 +/- 0.03 (P < 0.001), N - 0.190 +/- 0.03 versus 0.138 +/- 0.03 (P < 0.001) and D - 0.200 +/- 0.04 versus 0.152 +/- 0.03 (P < 0.001). No significant day-to-night differences were found in both groups. CONCLUSIONS: Steeper QT/RR slope and complete lack of day-to-night differences in VT/VF patients show inappropriate QT adaptation to the heart rate changes. The prognostic significance of this parameter needs prospective studies.

Predictors of long-term outcome in patients with left ventricular dysfunction following coronary artery bypass grafting.

BACKGROUND: Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction. AIM: The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction. METHODS: A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion l80 ms, premature ventricular contractions (PVC) l10/h, non-sustained ventricular tachycardia (nsVT), and SDNN L70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined. RESULTS: Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death. CONCLUSIONS: The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.

Correlation between electrical and mechanical properties of the left ventricle in patients with postinfarction ventricular tachycardia.

BACKGROUND: Electroanatomical mapping allows differentiation between viable and scarred myocardium. Echocardiography is widely used to assess myocardial contractility. The relationship between electrophysiological and echocardiographic assessment of left ventricular function has not yet been well established. AIM: To correlate mechanical and electrical function of the left ventricle in patients with postinfarction ventricular tachycardia and to assess clinical, echocardiographic and angiographic parameters affecting regional electrical function. METHODS: In 32 patients (25 males, 64+/-9 years old) mean unipolar (UP) and bipolar (BP) voltages were obtained with electroanatomical mapping (CARTO system) for a 12-segment model and compared with segmental wall motion function scored as normal, hypokinetic and a- or dyskinetic. UP voltage in individual groups of segments was: 7.8+/-4.2 mV, 6.5+/-4.2 mV, 4.7+/-2.5 mV, p <0.01 and for BP voltage 2.1+/-1.5 mV, 1.9+/-1.9 mV, 1.1+/-1.0 mV, p < 0.01, respectively. Left ventricular ejection fraction < or =30%, end-diastolic diameter >56 mm, previous inferior or anterior myocardial infarction (MI), MI < or =5 years and open infarct-related artery were associated with lower voltage in normokinetic segments. CONCLUSIONS: Segments with advanced systolic dysfunction had significantly lower uni- and bipolar voltage than normo- and hypokinetic segments. However, preserved local electrical function could be found in a/dyskinetic regions. Left ventricular remodelling, time and location of MI and patency of infarct-related artery influenced voltage in normokinetic segments.

The use of myocardial contrast echocardiography in the assessment of left ventricular function recovery after primary percutaneous coronary intervention in the setting of acute myocardial infarction.

BACKGROUND: Despite successful reperfusion therapy of acute myocardial infarction and complete restoration of infarct-related artery patency, the improvement of systolic function in long-term outcome depends on preserved microvasculature integrity. Myocardial contrast echocardiography (MCE) is a useful technique for identification of viable myocardium. AIM: To assess the value of real-time myocardial contrast echocardiography (rt-MCE) in prediction of left ventricular function improvement in patients with anterior wall acute myocardial infarction as well as selection of the optimal cut-off value for the number of dysfunctional segments with preserved complete perfusion, in order to predict the global left ventricular function improvement during one-month observation. METHODS: Rt-MCE was performed in 74 patients (50 men, aged 58+/-11 years) with anterior wall myocardial infarction, treated with primary percutaneous coronary intervention (PCI) within 12 hours from the onset of symptoms. After estimation of regional contractility disturbances and global systolic function of the left ventricle, rt-MCE was performed with contrast assessment of dysfunctional segments (normal contrast pattern=2, heterogeneous=1, lack of contrast=0). Regional perfusion score index (RPSI) was calculated by adding the perfusion indices and dividing by the number of dysfunctional segments. RESULTS: Of a total of 1184 visualised segments, 344 (29.1%) were dysfunctional (189 hypokinetic, 155 akinetic). Contractility improvement was observed in 192 segments (preserved viability in 105 hypokinetic and 37 akinetic segments). In a group of 44 patients with systolic function improvement, 34 of them had preserved viability, and in a group of 30 patients without LVEF improvement, in 22 of them myocardium viability was not observed. Sensitivity, specificity and accuracy of rt-MCE in prediction of left ventricular global improvement were 72.7%, 73.3% and 73%, respectively, whereas in prediction of regional function improvement these values were 73.9%, 77% and 75.5%, respectively. CONCLUSION: Rt-MCE performed in the early phase of myocardial infarction enables the prediction of left ventricular regional and global function improvement in patients treated with primary PCI.

Diagnostic utility of tissue tracking echocardiography for the diagnosis of ischaemic heart disease.

INTRODUCTION: Both the resting electrocardiogram and standard echocardiography have limited value in detecting ischaemic heart disease (IHD) in patients with atypical symptoms or asymptomatic subjects. Tissue tracking (TT) is a novel method based on tissue Doppler echocardiography for the assessment of longitudinal apical myocardial motion. AIM: To assess diagnostic utility of TT mode in the diagnosis of IHD. METHODS: The study was performed in a group of 36 patients (aged 58+/-8 years, 15 males) with good acoustic window, sinus rhythm and normal left ventricular ejection fraction on standard echocardiography who were previously selected for coronary angiography. Systolic displacement of myocardium (TT) was assessed in all patients using apical views (4, 2, and 3-chamber) and 7-colour-coded visualisation expressing various apical displacements of the myocardium during systole. Group IHD(-) consisted of 16 patients with normal coronary angiography or insignificant lesions and group IHD(+) consisted of 20 patients with significant (>70%) coronary lesions. RESULTS: Despite similar prevalence of arterial hypertension and diabetes as well as similar pharmacological treatment patients from the IHD(+) group had a lower TT index (ratio of the sum of regional TT values to the number of analysed segments than the IHD(-) (patients 4.5+/-0.8 mm vs 5.9+/-0.9 mm respectively, p <0.001). CONCLUSIONS: Resting echocardiography with tissue tracking enables fast, non-invasive and semiquantitative evaluation of left ventricular function. This method of assessment of longitudinal layers of the left ventricle may be useful in the diagnosis of ischaemic heart disease.

[Prediction of adverse cardiac events in patients with acute anterior wall myocardial infarction treated with PCI]. / Przewidywanie wystapienia niekorzystnych zdarzen sercowych u chorych ze swiezym zawalem miesnia sercowego sciany przedniej leczonych PCI.

UNLABELLED: Despite common use of reperfusion therapy, particularly primary PCI during acute myocardial infarction, steadily increasing number of patients with low left ventricular ejection fraction, with heart failure (HF), requiring frequent rehospitalisation justifies the study establishing the best indices of prediction of major adverse cardiac events (MACE) occurrence. The aim of the study was to define the frequency of MACE (death, re MI, sVT, rehospitalisation for HF) in patients with acute anterior wall myocardial infarction in 6 month follow up and the factors determinatig its occurence. The 115 consecutive patients (86 males of age 57.7 +/- 11 yrs) with first anterior MI were studied. After successful PCI (TIMI 3) the angiographic assessment was performed (MBG 0-1 - no perfusion, MBG 2-3 - perfusion preserved). During first 48 hours 12-lead ECG was monitored in order to analyse the time to reduction of ST elevation in the lead with the highest elevation (deltatST 50%). On 2nd day LV function (LVEF and WMSI) and dyssfunctional segment perfusion (RPSI) were assessed. On 5th day Holter monitoring with arrhythmia and time domain parameters (SDNN, rMSSD) of heart rate variability were performed, on 30 day TWA test was done. RESULTS: During 180 follow-up 18 MACE occurred (3 death, 2 MI, 11 rehospitalisations for HF). In univariate analysis cigarette smoking, higher maximum troponin I value, LVEDV, LVESV, ST elevation sum, longer time to reduction of ST elevation, lower LVEF and RPSI, lack of microvessel integrity and positive TWA test had significant relationship with occurrence of MACE. The multivariate analysis of Cox proportional risk regression demonstrated that only lower value of RPSI and LVEF, longer time of ST elevation reduction in the lead with the highest ST elevation and positive TWA test were independent indices of MACE prediction. CONCLUSIONS: Cumulative evaluation of LVEF, indices of preserved perfusion and results of TWA test turned out to be the best predictors of MACE occurrence in 6 month follow up in patients after anterior MI treated with PCI.