The influence of obesity on progression of coronary arteriosclerosis and clinical course after ST elevation acute myocardial infarction treated with primary coronary interventions.

PURPOSE: Evaluation of influence of obesity on the coronary atherosclerosis development and clinical outcome in patients with STEMI treated by PCI with BMS implantation. MATERIAL AND METHOD: 82 patients (64 men) treated with PCI within 6 hours from 1st STEMI. Three groups of pts were formed according to BMI. Based on coronary angiography number of significant stenoses (NSS), number of stenosed coronary arteries (NSA), and sum of significant stenoses (SSS) were calculated. Echocardiography examination was performed 3 days and 6 months after STEMI. Serial evaluation of TnI, CK, CKMB was performed after admission, and serum BNP was assessed after 2 days, 1 and 6 months after STEMI. RESULTS: Obese patients revealed higher values of NSA, NSS and SSS than patients with normal BMI and overweight. There were no differences of BNP, maximal values and AUC of CK, CKMB, TnI and echocardiographic parameters between all groups whereas decrease of BNP during follow-up correlated with BMI. CONCLUSIONS: Results of our prospective study indicate that in obese patients, there is a significantly greater number of atherosclerotic lesions in coronary arteries found during PCI, as compared to those with normal body weight or overweight. We proved that overweight and obesity did not result in significantly greater damage to the myocardium and left ventricular dysfunction, both in the acute phase and 6 months after myocardial infarction treated with primary coronary intervention, as compared to those with normal body weight. In addition correlation was found between BNP concentration profile and body mass index in the 6-month follow-up after STEMI treated with PCI and bare metal stent implantation.

Ambiguity of morphological criteria of myocarditis in cardiac biopsy specimens.

Myocarditis is diagnosed when leukocytic infiltrate is accompanied by myocyte degeneration or necrosis. Endomyocardial biopsy is evaluated as the main diagnostic method. The purpose of the present study was to examine the individual elements of a histological picture and specify morphological criteria of diagnosing myocarditis in cardiac biopsy. The Dallas criteria were the point of reference. In the cardiobiopsies from 70 patients with clinically suspected myocarditis or congestive cardiomyopathy an active myocarditis was found in 19 cases, significantly more frequently in the group clinically classified as having myocarditis. Contraction bands, endocardial changes and vasculopathy were more frequent in cases histologically classified as active myocarditis than in borderline myocarditis. In our opinion the Dallas criteria include certain ambiguities concerning mainly differences of individual types and phases of myocarditis as well as their relations to congestive cardiomyopathy. The sensitivity and specificity of the diagnosis are related both to methodological limitations (material selection) and difficulties occurring mainly at the level of perception, evaluation and interpretation of changes. It is possible to improve the efficacy of cardiac biopsy in diagnosing myocarditis if a new techniques better revealing myocyte damage and more unequivocally determining the cellular composition of the stroma have been developed.

[Usefulness of electrocardiographic exercise tests for evaluation of percutaneous transluminal coronary angioplasty results]. / Przydatnosc elektrokardiograficznych testów wysilkowych dla oceny wyników przezskórnej angioplastyki tetnic wiencowych.

The value of exercise ECG (ExT) in predicting the occurrence of restenosis after successful single-vessel percutaneous transluminal coronary angioplasty (PTCA) was assessed in 94 patients (pts). There were 83 pts with complete and 11 with incomplete revascularisation. In all cases ExT were made prior to the procedure, immediately after, 3 and 6 months after PTCA. In group of 48 pts without restenosis an abnormal ExT was present in 19 (39.6%) pts immediately after PTCA and in 13 (27.1%) pts in 6 month of observation. Among 46 pts with restenosis an abnormal ExT was observed in 27 (58.7%) pts immediately after PTCA and in 42 (91.3%) pts in time of 6 months control. Four (8.7%) pts showed negative ExT despite of restenosis. After 3 months of observation multivariate analysis of 11 factors revealed 2 factors related to restenosis: ST segment depression and chest pain during ExT. The positive predictive value for restenosis was 60.5% for those factors. After 6 months of observation multivariate analysis revealed 3 factors related to restenosis: ST segment depression, double product and maximal blood pressure during ExT. The positive predictive value for restenosis was 64.7% for those factors. It is concluded that our diagnostic strategy provides a useful clinical tool for detecting patients with high risk of restenosis who may require repeated coronary angiography.

[Scintigraphic evaluation of myocardial perfusion after using TI-201 in patients before and after successful percutaneous transluminal coronary angioplasty]. / Scyntygraficzna ocena perfuzji miesnia sercowego przy uzyciu talu 210 u chorych przed i po skutecznej angioplastyce naczyn wiencowych.

We analysed 53 patients (43 men and 19 women) age 38-71. Exercise TI-201 scintigraphy was performed before PTCA, 6 to 10 days and 3 to 6 months after PTCA. Before PTCA in all the patients myocardial perfusion detects on scintigraphy were observed. The imaging performed 6 to 10 days after PTCA showed an improvement seen as a decrease in the number of ischaemic segment in 36 patients (67.9%) and total normalisation of scintigraphic picture in 12 patients. Coronary angiography performed 6 months after PTCA showed patency of the dilated vessel in 11 (91.3%) among these patients. In exercise TI-201 scintigraphy performed 3 to 6 months after PTCA normalised scan was observed in 20 patients, recurrence of stenosis was found only in 2 (10%) of those patients. In 33 patients with transient perfusion defects, angiographic restenosis was found in 22 (60%) patients. Predictive value of exercise TI-201 scintigraphy for occurrence of restenosis was established. Positive predictive value of the study performed 6 to 10 days after PTCA was 56%. Negative predictive values of such a study was 91%. Similarly, for detection of restenosis in scan performed 3 to 6 months after PTCA there was found a strong negative predictive value-90% and a weak positive predictive value-63%.

[Morphology of atheromatous change during and after PTCA and occurrence of restenosis]. / Morfologia zmiany miazdzycowej przed i po PTCA a wystapienie restenozy.

The frequency of restenosis incidence in a group of 72 patients after effective PTCA as well as dependence of its incidence on dilated coronary artery and morphology of sclerotic changes according to ACC/AHA classification were analyzed. The subject of analysis included also effect of the degree of residual stenosis on restenosis incidence as well as determining dependence between the degree of dissection after PTCA on restenosis rate. Restenosis was stated in 20 (20.7% percent) patients, in 26 cases (29%) among 88 dilated coronary arteries. Restenosis was more frequently observed in cases of left coronary artery dilatation. Analyzing restenosis occurrence in relation to morphology of sclerotic changes according to ACC/AHA classification its more frequent incidence in type B (35%) and type C (44%) in comparison type A--25% of this classification was observed. The percentage of residual stenosis was higher in the group of restenosis and amounted to 22.8% in comparison to the residual stenosis of 13% in the group of patients with no reported restenosis. Localized dissection can be a good predictor of results after successful PTCA. More frequent incidence of limited dissection took place in 34% of dilated coronary arteries without restenosis in relation to 20% of cases with restenosis. No evidence of dissection as well as long dissection after PTCA was associated with higher degree of restenosis. Angiographic evaluation of the morphology of sclerotic changes in view of degree of dissection after PTCA is a good predictor of results after angioplasty.

[Results and complications of PTCA]. / Wyniki i powiklania angioplastyki wiencowej.

Between January 1987 and June 1992 we performed 189 PTCA procedures in a group of 153 patients (127 men, 26 women) aged 28 to 69 years, mean 52.3. 203 coronary vessels were dilated. In 136 pts one vessel was dilated, one vessel with two narrowings were dilated in 16 pts and in 17 pts two-vessel PTCA was performed. Due to restenosis, PTCA was repeated, once in 26 pts, twice in 3 pts and three times in 1 patient. Effective dilatation was achieved in 81.8% of cases and in this number, circumflex and marginal branch of left coronary artery were successfully dilated in 90.7%, left anterior descending in 84.6%, right coronary artery in 84.2% of cases. Attempts to recanalize these vessels were effective in 52%. There were no lethal complications of PTCA, acute occlusion of artery occurred in 5.9% of dilated vessels. Emergency coronary bypass had to be performed in 5.2% pts due to acute artery occlusion. PTCA supported by surgical stand-by appears to be a safe procedure with high direct effectiveness.