[Massive pulmonary embolism without echocardiographic features of right ventricular overload]. / Masywny zator tetnicy plucnej bez cech przeciazenia prawej komory w badaniu echokardiograficznym.

A case of 70-year-old patient with massive pulmonary embolism confirmed in CT, but without changes in right ventricle size and function in echocardiography is presented. This case is consistent with literature data that echocardiography has relatively low sensitivity in the diagnosis of acute pulmonary embolism.

Prospective randomised study to evaluate effectiveness of distal embolic protection compared to abciximab administration in reduction of microembolic complications of primary coronary angioplasty.

BACKGROUND: Myocardial reperfusion following primary percutaneous coronary intervention (pPCI) is limited due to, among other things, microembolic events. Abciximab and a mechanical system of distal protection both reduce their incidence during PCI. AIM: Prospective, randomised study to compare effectiveness of abciximab and protection devices in reduction of microembolic complications during pPCI. METHODS: One hundred and twenty consecutive patients with ST elevation acute myocardial infarction referred for pPCI after coronary angiography were randomly assigned to the following groups: Group A (n=63), treated with abciximab; and Group B (n=57), treated using the distal protection system. Primary endpoint was blood flow through the infarct-related artery (IRA) using TIMI grading after pPCI; secondary endpoints included myocardial perfusion assessment using myocardial blush grade (MBG), ST resolution and improvement of echocardiographic left ventricular ejection fraction (LVEF) after pPCI. RESULTS: TIMI grade 3 flow after pPCI was obtained in 89% of patients in both groups, TIMI grade 2 flow in 5% (NS). Myocardial perfusion after pPCI assessed with MBG scored 3 in 66% of patients in group A and 62% of patients in group B (NS). ST resolution was present in 62% (26-84) in group A and 68% (41 - 86) in group B (NS). Logistic regression analysis showed no significant influence of selected variables on the primary endpoint. Analysis performed in the distal protection group revealed significant effects on the following factors on the final TIMI flow in IRA: presence of thrombus prior to pPCI (p=0.026), presence of residual thrombus after aspiration (p <0.001), and IRA diameter of > or =3.5 mm (p=0.01). Median LVEF in group A at sixth month of follow-up was 46% (44-50%), similar to group B - 46% (45-49%) (NS). CONCLUSIONS: Use of the PercuSurge distal protection device during pPCI allows angiographic and electrocardiographic measures of reperfusion to be improved. It has a similar effect on left ventricular systolic function as administration of abciximab. The device seems to be useful in patients with culprit artery diameter of > or =3.0 mm, and optimally > or =3.5 mm and thrombus visible on angiography. Successful initial thrombectomy prior to deployment of stent seems particularly important when using the PercuSurge system.

Cytomegalovirus infection in acute myocardial infarction. Is there a causative relationship?

BACKGROUND: Cytomegalovirus (CMV) infection has been suggested to play an important role in the pathogenesis of atherosclerosis. Whether CMV may be involved in the development of acute myocardial infarction (MI) has not yet been established. AIM: To asses the prevalence of active or latent CMV infection in patients with angina or acute MI. METHODS: The study group consisted of 158 subjects divided into three groups: group I - 70 patients (49 males, mean age 57.1+/-10.4 years) with acute MI, group II - 40 patients (21 males, mean age 59.1+/-7.9 years) with stable angina, and group III - 48 healthy controls (18 males, mean age 54.9+/-12.1 years). Anti-CMV IgM and IgG antibody titre in blood serum was measured in all subjects. In those in whom anti-CMV antibodies were present, quantitative polimerase chain reaction (Q-PCR) was performed in order to detect DNA of CMV in peripheral blood mono-nuclear cells (PBMC) and in serum. RESULTS: Anti-CMV IgM antibodies were not detected in any of the subjects. A positive result of anti-CMV IgG test was present in 60 (85.7%) patients from group I, 34 (85%) patients from group II, and 15 (31.5%) control subjects. The mean IgG antibody concentration was 72.2+/-13.6 aU/ml, 74.23+/-12.8 aU/ml and 19.57+/-3.56 aU/ml, respectively (p<0.001). In patients from group I, a significantly higher prevalence of serum DNA CMV was noted than in the remaining groups. CONCLUSIONS: Patients with symptomatic coronary artery disease have a significantly higher anti-CMV antibody titre than healthy subjects. The active form of infection is significantly more prevalent in patients with acute MI than in patients with stable angina.