[QT interval dispersion in hypertensive diabetics and in patients with hypertension with chronic heart failure without diabetes]. / Disperzia QT intervalov u hypertonických diabetikov a u pacientov s hypertenziou bez diabetu s chronickým srdcovým zlyhaním.

AIM: Our aim was to: 1. compare QT dispersion from routine ECG in diabetic and no-diabetic patients with congestive heart failure, 2. describe associations between QT dispersion and circadian blood (BP) pressure variation in type 2 diabetic patients with congestive heart failure (CHF). PATIENTS AND METHODS: 122 patients admitted to hospital due to CHF in the period between years 2000-2001 have been divided into 2 groups: group 1:70 patients (m: 40, f: 30, mean age 64.7 +/- 9 years) with type II diabetes mellitus (DM), group 2:52 patients (m: 28, f:24, mean age 62.5 +/- 10.9 years) without DM. Diagnosis of CHF was made clinically and proved by ECG and ECHO (EF < 40%), DM was defined clinically or by using oral glucose tolerance test (75 g glucose, 2 h blood glucose > 11.1 mmol/l). The QT interval was measured from the beginning of the QRS complex to the end of the T wave from routine 12-lead ECG. QT intervals were corrected for heart rate using Bazett's formula. QT dispersion (QTd) and rate corrected QT dispersion (QTc) were defined as the difference between the maximum and minimum QT and QTc intervals, respectively. Ambulatory blood pressure (AMBP) was measured by an oscillometic technique. Diabetic patients with CHF were divided both according to below and above the median QTc dispersion (65 ms). STATISTICAL ANALYSIS: Chi-square and Student's t-test. Significant differences were assumed of p < 0.05. RESULTS: Both groups were matched by gender, age, duration and intensity of hypertension, the presence and intensity of obesity, hyperlipidemia (TC, TG, LDL-C, HDL-C) and smoking habits. Diabetic patients with CHF had significantly longer QTc interval (maximum and minimum), QT dispersion and QTc dispersion compared with non-diabetic patients with CHF. Diabetic patients with CHF with QTc dispersion > 65 ms had significantly higher night systolic (133 +/- 14 vs. 112 +/- 14) and diastolic (80 +/- 11 vs. 65 +/- 6) BP and significantly higher night/day ratio for both systolic (0.94 +/- 0.05 vs. 0.86 +/- 0.06) and diastolic (0.89 +/- 0.07 vs. 0.80 +/- 0.05) compared with diabetic patients with CHF with QTc dispersion < 65 ms. CONCLUSION: Diabetic patients with CHF are higher risk than non-diabetic. Our data describe both factors related to cardiovascular risk in diabetic patients with CHF-prolongation of the QT and QTc dispersion and reduced nocturnal blood pressure.

[Effect of chronic Chlamydia infection with non-specific inflammation on cardiovascular complications in acute myocardial infarct]. / Vplyv chronickej chlamydiálnej infekcie s nespecifickým zápalom na kardiovaskulárne komplikácie pri akútnom infarkte myokardu.

It is known that local and systemic inflammatory processes play an important role in the genesis and development of atheroclerotic lesions and in the pathophysiology of acute coronary syndromes. This hypothesis is supported by findings of elevated parameters of the "inflammatory" reaction in the affected blood vessels but also in the blood of atherosclerotic patients. Known risk factors do not explain quite satisfactorily epidemiological cardiovascular phenomena and different manifestations of coronary heart disease. It is very probable that also Chlamydia pneumoniae is a risk factor. This assumption is based on evaluation of seroepidemiological data, examination of atherosclerotic plaques not only in humans but also in animal models with chlamydial infection. Based on retrospective and prospective evaluation of case-records the authors analyzed the incidence of cardiovascular complications in 83 patients with acute myocardial infarction (AIM), incl. 51 patients (31 men and 20 women, mean age 64.4 +/- 3.4 years who had a non-specific inflammation and chlamydial infection, and 32 patients (24 men and 8 women, mean age 64.7 +/- 3.6 years) who had chlamydial infections but no non-specific inflammation (in the blood). These patients were selected from all patients hospitalized during 1998-2001. When diagnosing acute myocardial infarction we applied WHO criteria, and the presence of at least two of three criteria was necessary: a history of prolonged (more than 20 min). stenocardia, electrocardiographic changes typical for ischaemia and/or necrosis and elevation of myocardial enzymes in serum, Non-specific inflammatory activity was present in patients (i.e. positive) if the following laboratory parameters were recorded: C-reactive protein > 5 mg/l assessed by the radial immunodiffusion method; fibrinogen > 4 mg/l assessed by the coagulation method according to Claus; leukocytes > 9.6 x 10(3)/microliter, leukocytes were counted automatically in a Coulter chamber; lymphocytes > 3.4 x 10(3)/microliter. Red cell sedimentation rate > 20 mm/hour. The activity was evaluated as positive when all parameters were elevated. The presence of chronic infection with Chlamydia pneumoniae was assessed qualitatively by antibody positivity (IgG) in serum using the microimmunoflurescent method (using a set from Labsystems Co.). The incidence of associated risk factors (obesity, smoking, diabetes, hyperlipidaemia and hypertension) is higher in the sub-group of patients with Chlamydia infections without inflammation, however, the difference is not statistically significant. The incidence of cardiovascular attacks was higher in the sub-group of patients with chlamydial infection and concurrent inflammation as compared with the sub-group of patients with chlamydial infection without inflammation. In case of re-infarction of the myocardium, a sudden cerebrovascular attack, death and arrhythmia the difference was statistically significant, while in case of cardiac failure and cardiogenic shock the difference was not significant. Patients with acute myocardial infarction with chlamydial infection and a concurrent non-specific inflammation had to be treated more often by combined (i.e. more intense) treatment, thrombolytic treatment, PTCA and surgery (bypass) of the coronary vessels as compared with patients with Chlamydia infections but without inflammation. The authors assume therefore that not only different risk factors but also the effect of non-specific inflammation and Chlamydia infection contribute towards the increased number of cardiovascular postinfarction complications. Therefore a therapeutic approach involving eradication of infection and suppression of the inflammatory reaction should be considered.

Beta-blockers in heart failure.

The problem of heart failure (HF) has become a topic of great interest. Until recently, the use of beta-blockers in patients with HF was considered as one of the contraindications which were taught to medical students as realities with a strict policy to avoid them in HF patients. Times have changed and the contraindicated drug is now an advised and preferred one to be used in HF patients with certain advised recommendations for its use in a safe and beneficial way. Even though the use of beta-blockers in HF patients is an important and necessary step towards an optimal treatment of these patients as most of the big studies have proved, still we need to emphasize these benefits in order to achieve more application of these agents in HF patients. Here we analyse the major studies which used beta-blockers in HF patients. It seems that beta-blockers have to be used in all patients with HF with reduced ejection fraction unless a real contraindication exists as they bring up a great benefit towards decreasing mortality and morbidity.

Benefits of beta-blockers in heart failure.

The problem of heart failure (HF) has become a topic of great interest. Until recently, the use of beta-blockers in patients with HF was considered as a contraindication. Times have changed and the contraindicated drug is now an advised and preferred one to be used in HF patients with certain advised recommendations for its use in a safe and beneficial way. Still we need to emphasize the benefits of these agents in order to achieve more application in HF patients. Here we try to stress the proved beneficial effects of beta-blockers by major studies in HF patients, and to supply the reader with practical information regarding the use of these agents with a look at the frequency of using them and the possible reasons behind their underuse. The files of heart failure patients admitted to 1st Internal Department in the University Hospital in Bratislava in the period between January and December 1997 were checked to show the magnitude of using beta-blockers in them. Among 150 patients admitted during the above mentioned period only 30 patients (20%) received beta-blockers. It seems that beta-blockers have to be used in all patients with HF with reduced ejection fraction unless a real contraindication exists, but the actual data shows that beta-blockers are still underused. (Tab. 2, Ref. 30.)

[Significance of left ventricular hypertrophy in hypertension]. / Význam hypertrofie l'avej komory u hypertonikov.

Left ventricular hypertrophy (LVH) is supposed to be a useful marker of cardiovascular (CV) complications during the course of hypertension (HT). To evaluate it, authors compared the clinical findings in hypertensive patients (pts) with and without LVH defined by echocardiography (echo). Hospital records of hypertensives treated in the 1st Medical Department during the year 1995 were analysed. LVH was defined by echo (Penn convention) as left ventricular mass index (LVMI) > 125 g/m2 in men and > 115 g/m2 in women. Presence of LVH was found in 72 pts (mean age 66 y), absence of LVH in 38 pts (mean age 56 y). There were statistically significant more CV complications in LVH-positive pts (incidence of myocardial infarction, arrhythmias, heart failure, ischemia (ECG), mitral regurgitation) as in LVH-negative. Tendency for other complications in LVH-positive pts (incidence of renal failure, stroke, LV diastolic dysfunction and aortic regurgitation) was also present. LVH-positive pts were about ten years older than the LVH-negative. In other risk factors (LVH and age not included) the both groups of pts were matched. LVH in pts with HT brings usually a complicated course of the disease. Age is an important contributing factor. Authors recommend to look after LVH presence in hypertensives as it carries much more complicated course of the disease.