Obstructive hypertrophic cardiomyopathy is associated with enhanced thrombin generation and platelet activation.

OBJECTIVES: To investigate the association of left ventricular outflow tract (LVOT) obstruction with blood coagulation, platelet activity and inflammatory response in patients with hypertrophic cardiomyopathy (HCM) and sinus rhythm. PATIENTS AND MAIN OUTCOME MEASURES: In 42 patients with HCM with sinus rhythm, including 16 patients with resting LVOT obstruction (gradient > or = 30 mm Hg) and 29 age- and sex-matched controls, markers of thrombin generation (thrombin-antithrombin complex (TAT), prothrombin fragment 1+2 (F1+2)), platelet activation (soluble CD40 ligand (sCD40L), beta-thromboglobulin (beta-TG), P-selectin) and inflammation (C-reactive protein (CRP), interleukin (IL)6, tumour necrosis factor-alpha (TNFalpha)) were determined. RESULTS: Thrombin, platelet and inflammatory markers were higher in the entire HCM group than in controls (p<0.005 for all compared parameters). Compared with non-obstructive HCM, obstructive HCM was associated with increased thrombin formation (TAT, F1+2), platelet activation (sCD40L, beta-TG, P-selectin) and both CRP and IL6 levels. Only the level of TNFalpha was similar in both forms of HCM. In contrast, a comparison of non-obstructive HCM with controls showed that all these variables (except for P-selectin) were similar; P-selectin was higher in non-obstructive HCM. The LVOT gradient correlated positively with all the raised blood markers (r from 0.39 to 0.73; p<0.05), except for TNFalpha. In multiple regression analysis models, the LVOT gradient was the only independent predictor of TAT (R(2) = 0.61; p<0.001), sCD40L (R(2) = 0.59; p<0.001), F1+2 (R(2) = 0.55; p = 0.002), P-selectin (R(2) = 0.49; p = 0.004) and beta-TG (R(2) = 0.38; p = 0.005) in patients with HCM. CONCLUSIONS: LVOT obstruction is independently associated with enhanced thrombin generation and platelet activity in patients with HCM with sinus rhythm.

Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis.

An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.

Association of increased carotid intima-media thickness with the extent of coronary artery disease.

OBJECTIVE: To investigate (a) the relation between intima-media thickness (IMT) in carotid arteries and the extent of coronary artery disease (CAD); and (b) whether IMT is predictive of coronary atherosclerosis. The coexistence of severe extracranial atherosclerosis in patients with CAD was also analysed. METHODS: Coronary angiography and carotid ultrasound evaluation were performed in 558 consecutive patients (438 men), with a mean (SD) age of 58.8 (9.2) years and suspected CAD. Mean IMT was measured at both carotid arteries and expressed as the mean aggregate value. The relation between IMT and severity of CAD was determined. RESULTS: A significant correlation between mean IMT and advancing CAD (p < 0.0001) was found. Four independent predictors of CAD were found in the discriminant analysis: age (p = 0.0193), hyperlipidaemia (p < 0.0001), smoking (p = 0.0032), and IMT (p < 0.0001). A significant increase in IMT was observed among patients with one, two, and three vessel CAD. A log normal distribution of IMT values showed that if mean IMT was over 1.15 mm, patients had a 94% probability of having CAD, with sensitivity of 65% and specificity of 80% in the patients with a high risk of CAD. The number of critically stenosed extracranial arteries increased with advancing CAD. None of the patients with normal coronary arteries had severe stenosis of the extracranial arteries. Severe carotid, vertebral, or subclavian stenosis was found in 16.6% of patients with three vessel CAD. CONCLUSIONS: IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD.

Comparison of dual-chamber pacing with nonsurgical septal reduction effect in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: The aim of the study was to compare the influence of dual-chamber pacing vs. nonsurgical septal reduction on hemodynamic and morphological parameters in patients with obstructive form of hypertrophic cardiomyopathy. METHODS: Nineteen patients with dual-chamber pacing (group I) and 9 patients who underwent nonsurgical septal reduction (group II) were studied at baseline and after a 6-month follow-up. The changes of left ventricular outflow tract gradient and posterior wall thickness (as an index of left ventricular hypertrophy regression) were compared. RESULTS: The baseline left ventricular outflow tract gradient was comparable between group I and group II (77+/-25 vs. 82+/-25 mm Hg, p>0.05). At 6-month follow-up, the left ventricular outflow tract gradient was reduced to a similar level in both groups (28+/-19 vs. 25+/-12 mm Hg, p>0.05). At baseline, posterior wall hypertrophy was comparable between groups (12.9+/-1.7 vs. 13.6+/-2.2 mm, p>0.05). During follow-up, the posterior wall thickness was unchanged in the pacing group (12.9+/-1.7 vs. 12.6+/-1.6 mm, p>0.05), whereas nonsurgical septal reduction induced regression of left ventricular hypertrophy in myocardial region remote from the infarcted septal segment (13.6+/-2.2 vs. 10.5+/-2.3 mm, p<0.003). CONCLUSION: Despite comparable reduction of instantaneous left ventricular outflow tract gradient, the nonsurgical septal reduction decreased posterior wall thickness, whereas pacing did not reduce left ventricular hypertrophy. Thus, regression of left ventricular hypertrophy that appeared solely after nonsurgical septal reduction may reflect the more permanent reduction of left ventricular pressure overload. Thus, not only hemodynamic but also morphological benefit from nonsurgical septal reduction seems to indicate the superiority of this method over dual-chamber pacing.

Incidence of Chlamydia pneumoniae infection in patients with coronary artery disease subjected to angioplasty or bypass surgery.

BACKGROUND: Seroepidemiological, pathological and animal studies suggest that chronic infection with Chlamydia pneumoniae (Cp) may directly impact the development or progression of atherosclerosis and coronary heart disease. The aim of the present study was to determine the seroprevalence of Cp infection and markers of systemic inflammation in patients undergoing routine coronary artery examination and prior to heart revascularization. MATERIAL AND METHODS: The research involved 76 patients with severe CAD and 81 control patients with normal coronary circulation confirmed by coronary angiography. The presence of serum IgG and IgA antibodies to Cp and plasma interleukin-8 (IL-8) levels was measured by EIA test. Furthermore, the levels of plasma C-reactive protein, fibrinogen, total cholesterol, and triglycerides were measured in all patients. RESULTS: Seropositivity to Cp was found in 60.5% for IgG and in 61.8% of cases for IgA with CAD patients, as compared to 26.0% and 29.5% in the controls (p<0.001), respectively. The levels of Interleukin-8, plasma fibrinogen, total cholesterol and triglycerides were significantly higher (p<0.001) in the CAD group, while C-reactive protein tended to have a higher value in patients with atherosclerosis than in the control group, although the difference was not significant. CONCLUSIONS: Cp infection significantly increases the risk of CAD, usually requiring coronary bypass surgery or percutaneous coronary intervention as effective measures. It may also modify the levels of serum lipids, CRP and fibrinogen, increasing the risk of atherosclerosis. The strong correlation between the elevated IgG and IgA titers of Cp in patients treated with angioplasty or surgery may impact their follow-up; this issue requires further investigation.

[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.

[Atrial septal defect in adults--opinions, procedures and controversies]. / Ubytek w przegrodzie miedzyprzedsionkowej u doroslych--poglady, postepowanie i kontrowersje.

Atrial septal defect (ASD) accounts for 30-40% of congenital heart disease in adults diagnosed after the age of 40 and is after bicuspid aortic valve and mitral-valve prolaps the most common congenital cardiac malformation in adults. We have discussed current views on the pathological role of ASD in adults and controversies regarding its treatment. It is expected that increasing understanding of ASD pathophysiology, improved diagnostic methods and the possibility of transcatheter closure of interatrial defects will improve the treatment of patients with ASD.

Long-term outcome in patients with unstable angina treated by coronary balloon angioplasty.

UNLABELLED: Comparison of balloon angioplasty results in 472 patients with stable angina (SA) and 158 patients with unstable angina (UA) in 5-year follow-up is reported. Clinical success rate did not differ significantly, while periprocedural complications rate was higher in UA group (22.3 vs. 11.1%, P<0.001). During follow-up UA patients demonstrated higher: restenosis rate (48.5 vs. 30.4%, P<0.001), incidence of myocardial infarction (8.8 vs. 3.0%, P=0.004), although cardiac mortality did not differ significantly (2.2 vs. 1.6%). Reintervention rate in patients with unstable angina resultant from restenosis or significant artherosclerosis progression in coronary vessels, or originating from both of them, was also higher (53.7 vs. 34.1%, P<0.001). Event-free survival was significantly lower in UA patients (43.4 vs. 61.3%, P=0.02). The uni- and multivariate analysis proved that unstable angina was an independent risk factor in restenosis, re-intervention and cardiac events rate, despite perceptible differences in the baseline characteristics. Sub-group analysis of UA patients according to Braunwald classification revealed lower success rate and higher incidence of myocardial infarction during follow-up in post-infarction angina (class C), whereas new onset, no-rest angina (class I) had higher event-free survival in comparison with rest angina (classes II and III). CONCLUSIONS: UA patients treated by balloon angioplasty had higher periprocedural complications rate, as well as restenosis and re-intervention rate. Despite higher cardiovascular events rate during 5-year follow-up in UA group, survival rate in both groups was high and cardiac mortality did not differ significantly. Unstable angina constitutes a strong independent risk factor in adverse long-term outcome.

[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part III. Secondary prevention of ischaemic heart disease after discharge]. / Krakowski Program Wtórnej Prewencji Choroby Niedokrwiennej Serca. Czesc III: Wtórna prewencja choroby niedokrwiennej serca w okresie poszpitalnym.

UNLABELLED: Even though the majority of actions undertaken within the secondary prevention of ischaemic heart disease should be initiated while the patient is still hospitalized, the maximum benefit (measured as decreased cardiovascular risk) achieved depends mostly on the continuation and modification of these actions in the postdischarge period. There is not much known about the quality of medical care provided for patients after hospitalization due to ischaemic heart disease. The aim of the study was to assess the quality of postdischarge care in the field of secondary prevention of ischaemic heart disease. METHODS: Consecutive patients (age > or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: acute myocardial infarction, unstable angina, CABG and PCI. Out of 536 patients 418 took part in the control visit 6-18 months after discharge. Risk factors and medication used were assessed. RESULTS: High total cholesterol (> or = 5.2 mmol/l) was found in 65.8% of patients, high blood pressure (> or = 140/90 mmHg) in 46.2%, obesity (BMI > or = 30 kg/m2) in 24.6%, fasting glucose over 6.0 mmol/l in 17.7% and smoking in 16.3%. The frequency of antiplatelet drugs and beta-blockers use decreased whereas that of lipid-lowering drugs increased in the postdischarge period. The highest frequency of use of antiplatelets and lipid-lowering drugs, as well as the best control of hypercholesterolemia was found in the PCI group, whereas the lowest frequency of smoking was found in the CABG group. CONCLUSIONS: Insufficient control of risk factors and the frequency of secondary prevention using drugs was found. There is a need to intensify secondary prevention in patients with ischaemic heart disease in the postdischarge period.

[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part II. Secondary prevention of ischaemic heart disease during hospitalization]. / Krakowski Program Wtórnej Prewencji Choroby Niedokrwiennej Serca. Czesc II: Wtórna prewencja choroby niedokrwiennej serca w okresie hospitalizacji.

UNLABELLED: Hospitalization due to ischaemic heart disease provides a possibility to introduce patients education, to initiate non-pharmacological treatment and to assure patient compliance. The aim the study was to assess the frequency of risk factors and the quality of care in the field of secondary prevention in patients hospitalized due to acute coronary syndromes or subjected to myocardial revascularization. METHODS: The study was carried out in cardiac departments of six hospitals serving the area of the city. Consecutive patients (age < or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: first or recurrent acute myocardial infarction, first or recurrent unstable angina, first coronary artery bypass grafting or first percutaneous coronary intervention. RESULTS: Data of 536 patients (140 women and 396 men; mean age--56.6 +/- 8.4 years; hospitalized from 1.07.1996 to 30.09.1997) were collected from medical records. The rate of blood pressure measurement during the first 24-hours of hospitalization was 88.8%. Total cholesterol, HDL cholesterol, and triglycerides were assessed in 32.8%, 30.2%, and 32.3% of patients respectively during the first 24-hours of hospitalization. The height and weight were found in 54.9% and 85.1% of medical records. Obesity (BMI > or = 30 kg/m2) was found in 20.3% of patients, 36.7% smoked, 56.0% had hypertension, 15.5% diabetes and 79.5% had hyper-cholesterolemia. Medication at discharge was: antiplatelet drugs 86.7%, beta-blockers 66.4%, ACE inhibitors 50.2% and lipid lowering drugs 27.1%. CONCLUSION: There is a need to initiate a comprehensive programme in order to improve quality of care in the field of secondary prevention of ischaemic heart disease.

Predictive potential of noninvasive methods, inclusive of exercise SPECT Tc99m MIBI imaging, in recognition of high-risk patients with left main coronary artery stenosis.

The aim of the present study was to determine which clinical, exercise and perfusion variables can be instrumental in the identification of left main coronary artery. A multivariate model for prediction of left main disease was developed, based on a number of clinical, exercise and MIBI perfusion variables in two groups of patients. Group I consisted of 38 patients (30 men and eight women) with angiographically proven left main stenosis, while group II consisted of 41 patients (27 men and 14 women) with multivessel coronary artery diseases. A multivariate logistic regression analysis demonstrated that clinical variables including diabetes, hypertension, together with history of typical angina were the only independent predictors of left main stenosis. It was found that p value was 0.05 for hypertension, 0.01 for diabetes as well as 0.01 for the history of typical angina in clinical examination. No exercise or perfusion variables may be instrumental in prediction of left main stenosis, when considered in isolation. Myocardial perfusion by itself is therefore not deemed sufficiently specific to attempt its positive identification. High-risk patients with left main disease can be identified noninvasively by exercise perfusion imaging using a model based on the proposed logistic regression analysis with clinical variables.

[Percutaneous closure of atrial septal defect]. / Metoda przezskórnego zamkniecia ubytku w przegrodzie miedyprzedisonkowej.

Present state of knowledge about dynamically developing procedure of percutaneous atrial septal defect closure has been collected on the basis of the contemporary literature review. History of the method has been presented and a brief characteristics of implants used nowadays has been made with emphasis on their advantages and disadvantages. Technique and possible complications of the procedure have been described. Indications and contraindications to this way of treatment have been quoted. Comparison of percutaneous and surgical treatment has been made with indication of benefits following the less invasive character of percutaneous treatment.

[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.

[Long term outcome in patients with and without restenosis after coronary angioplasty]. / Odlegle obserwacje u chorych z restenoza i bez nawrotu zwezenia po angioplastyce wiencowej.

Restenosis at dilatation site still constitutes a significant limitation of percutaneous coronary revascularisation. Majority of patients with restenosis are treated with repeat angioplasty, although its impact on long-term outcome is still little known > Very few studies focused on this issue bring rather discrepant results. The present study is aimed at assessing the impact of restenosis on long-term outcome in patients treated with coronary angioplasty. A group of 567 patients, who in the years 1987-1996 had successfully undergone percutaneous balloon coronary angio-plasty (PTCA) at our Clinic, was retrospectively divided into two groups: a group comprising 188 patients (33.2%) suffering from recurrent angina in whom restenosis had been established through control angiography, and a group comprising 379 patients (66.8%) who during the observation period exhibited no angina symptoms, or in whom the control angiography did not reveal restenosis. The restenotic patients were older (p = 0.007), more frequently exhibited symptoms of unstable angina upon PTCA (p < 0.0001), and there were also fewer smokers among them (p = 0.02). Furthermore, restenotic patients more frequently had multivessel and multilesion angioplasty (p = 0.025; p = 0.004, respectively). Restenosis after the first PTCA was treated by repeated angioplasty in 149 (79.3%) patients, 26 (13.8%) underwent CABG operation and 13 (6.9%) patients were treated pharmacologically without repeated revascularization. Within the 5-year observation period the mortality rate in both groups did not differ significantly (5.9% vs. 4.0%). Restenotic patients sustained myocardial infarctions more frequently (8.0% vs. 3.2%, p = 0.01), had significant atherosclerosis progression (37.2% vs. 15.0%, p < 0.0001), and were more frequently subjected to repeated interventions (37.2% vs. 15.0%, p < 0.0001), both PTCA (79.3% vs. 11.6% p < 0.0001) and CABG surgery (32.5% vs. 4.2%, p < 0.0001), as well as to multiple re-interventions (31.9% vs. 4.8%, p < 0.0001), in comparison with the non-restenotic ones. Analysis of functional status of patients assessed in compliance with the CCS criteria at the end of the observation period proved that significantly more non-restenotic patients did not experience angina, or experienced it rather sporadically (CCS Class 0 and 1). Logistic regression uni- and multivariate analysis proved that restenosis is an independent risk factor of myocardial infarction, reinterventions--also multiple ones--and cardiac events, although not mortality.

Long-term outcome of coronary balloon angioplasty in diabetic patients.

Diabetes is recognised to increase morbidity and mortality after coronary revascularization. We compared clinical outcomes in mean 5-year-long follow-up of coronary balloon angioplasty in diabetic and non-diabetic patients. We studied 621 patients undergoing elective angioplasty from 1987 to 1996. There were 60 (9.7%) patients with diabetes who were compared with 561 non-diabetic patients. Diabetics were older, more often obese, less frequently were current smokers, and less frequently had hypercholesterolaemia. Diabetic patients in comparison with non-diabetics had lower ejection fraction and more frequently had angioplasty of complex (B2 or C) lesions, but there were no differences between both groups in the other clinical and angiographic risk factors. Clinical success of angioplasty, as well as complications rate were similar in both groups. In follow-up restenosis occurred more frequently in diabetics (46.3 vs. 32.2%, P=0.03), resulting in significantly higher re-intervention rate (50.0 vs. 35.4%, P=0.03). Especially diabetic patients were more frequently referred to CABG (20.4 vs. 9. 9%, P=0.02). There were no significant differences in deaths (1.9 vs. 2.8%) and myocardial infarction (3.7 vs. 4.4%). Diabetics presented worse CCS status at the end of observation (Class 0 and I - 61.1 vs. 74.4%, P=0.037). Angioplasty proved to be a safe procedure in diabetic patients. Despite higher restenosis and re-intervention rate in diabetics, mortality as well as myocardial infarction rate was the same in both groups during mean 5-year follow-up.

[Assessment of the left ventricular function by tissue Doppler echocardiography]. / Ocena czynnosci lewej komory przy uzyciu tkankowej echokardiografii dopplerowskiej.

UNLABELLED: Myocardial velocity gradient is a new indicator of regional left ventricular contraction determined by a two dimensional tissue Doppler imaging technique. The main goal of this study was to compare myocardial velocity gradient in patients with old myocardial infarction and dilated cardiomyopathy to normal subjects. We assessed myocardial velocity gradient in 44 persons: 32 patients (19 men, 13 women, mean aged 51.2 +/- 6.1 years) and 12 healthy subjects (7 men, 5 women, mean age 49.3 +/- 8.3 years) who were divided into 4 groups. Group A--14 patients with old anteroseptal myocardial infarction, group B--7 patients with old posterior infarction, group C--11 patients with dilated cardiomyopathy and group D--12 healthy subjects. In normal subjects myocardial velocity gradient in the anteroseptal segment was mean 2.44 +/- 0.34 s-1 and in the posterior segment was 3.08 +/- 0.38 s-1. Myocardial velocity gradient in the infarct regions was significantly lower than in noninfarct regions as well as that in the corresponding regions in normal subjects. Gradient in the anteroseptal and posterior segments was in group A: 0.61 +/- 0.33 s-1 12.39 +/- 0.65 s-1, p < 0.001 respectively and group B: 2.11 +/- 0.45 s-1 10.91 +/- 0.34 s-1, p < 0.001 respectively. In patients with dilated cardiomyopathy gradient was significantly lower (nteroseptal segment 0.55 +/- 0.37 s-1, posterior segment 0.85 +/- 0.31 s-1) than that in normal subjects (p < 0.001). CONCLUSION: Myocardial velocity gradient is a new indicator for the quantitative assessment of regional left ventricular contraction.

[Long-term results of coronary balloon angioplasty in various age groups]. / Wyniki angioplastyki wiencowej u chorych w róznych grupach wiekowych.

UNLABELLED: Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006). CONCLUSIONS: Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.