Appraisal of BSPM obtained from the limited lead system.

OBJECTIVE: Study goal was a comparative analysis of the characteristics of the isopotential maps, registered originally in the body surface potential mapping (BSPM) 87-lead (complete) cylindrical system, which were then transformed to the 30-lead (limited) spherical subsystem. METHODS: The comparative studies were carried out on the electrocardiogram (ECG) recordings recorded originally in the 87-lead BSPM Fukuda Denshi system (HPM-7100; Fukuda Denshi, Co., Tokyo, Japan) in a group of 21 patients with right bundle branch blocks (RBBB) with the mean age of 61.3+/-10.2 years. RESULTS: It was found that the body surface maps from the two multielectrode recording systems did not show any significant difference as to heart potential migration and distribution. It is worth noting that the maps created in the limited lead, spherical system gained the more realistic image, resulting from the effect of cardioelectric space symmetrization. CONCLUSION: The results led to conclusion that a procedure of spherical transformation to the system with the reduced number of the recording electrodes did not influence the core features of the body surface heart potential maps.

Mutation of the MYH7 gene in a child with hypertrophic cardiomyopathy and Wolff-Parkinson-White syndrome.

Familial hypertrophic cardiomyopathy (HCM) displays autosomal dominant inheritance with incomplete penetration of defective genes. Data concerning the familial occurrence of ventricular preexcitation, i.e. Wolff-Parkinson-White (WPW) syndrome, also indicate autosomal dominant inheritance. In the literature, only a gene mutation on chromosome 7q3 has been described in familial HCM coexisting with WPW syndrome to date. The present paper describes the case of a 7-year-old boy with HCM and coexisting WPW syndrome. On his chromosome 14, molecular diagnostics revealed a C 9123 mutation (arginine changed into cysteine in position 453) in exon 14 in a copy of the gene for beta-myosin heavy chain (MYH7). It is the first known case of mutation of the MYH7 gene in a child with both HCM and WPW. Since no linkage between MYH7 mutation and HCM with WPW syndrome has been reported to date, we cannot conclude whether the observed mutation is a common cause for both diseases, or this patient presents an incidental co-occurrence of HCM (caused by MYH7 mutation) and WPW syndrome.

[Changes of ventricular activation time in patients with left anterior fascicle block and bifascicular block]. / Zmiany czasu aktywacji komór u chorych z blokiem górnej wiazki lewej odnogi peczka Hisa i z blokiem dwuwiazkowym.

Recognition of left anterior fascicle block is usually a diagnostic problem. Isochrone maps, displaying results of the body surface potential mapping are helpful in solving this problem. The isochrone maps present changes of heart electric field, especially those concerning a pathway of the depolarization front propagation within the heart conduction system. Body surface potential mapping registrations were performed using a Fukuda Denshi cylindrical system, which enables simultaneous recordings of electrocardiographic signals from the 87 leads. The examined group consisted of 29 patients with left anterior fascicle block (LAFB) and complete right bundle branch block (RBBB) complicated by LAFB. The first group consisted of 7 females and 8 males with the mean age of 62 +/- 11.3 yr., and the second group comprised 8 females and 6 males (the mean age: 64 +/- 5.01 yr.). The control group comprised 30 healthy subjects--the mean age of 50.3 +/- 5.63 yr. In all of examined patients, elementary biochemical tests, echocardiography and X-ray chest examinations were performed. In order to obtain a pattern reflecting a depolarization trajectory in the patients' heart, the ventricular activation time maps (VAT) were constructed, using the own software. This kind of maps is more precise than standard electrocardiograms and makes possible monitoring an activity propagation, as well as its velocity within the heart conduction system. In the patients demonstrating left anterior fascicle block, a subendocardial layer of the bottom left surface of the interventricular septum is the earliest stimulated area of heart (similarly, as in normal subjects). Afterwards, the front of stimulation wave crosses the septum from left to right side. In the next phase, the activation comprises right surface of the septum, as well as subendocardial surfaces of right ventricle free walls, however in the free wall of left ventricle, as a result of left anterior fascicle block, the activation spreads through back part of bundle branch. At this moment, isochrone lines arrange in bottom-right-forward direction. Subsequently, the delayed stimulation wave penetrates the anterior and lateral walls. Isochrones on the right torso are directed rightward and upward. In the final phase, the activation spreads over remaining part of the free wall of left ventricle, moving leftward, upward and backward. On isochrone maps, the final stage of activation propagation is seen on whole upper back part of the torso. In patients demonstrating RBBB with LAFB, the stimulation time is notably delayed. As a result of blocking the right ventricle and left anterior fascicle, the stimulation wave goes to the free wall of left ventricle through the back bundle. Isochrones distribution is similar like in left anterior fascicle block. However, different time of stimulation dispersal in downward direction is observed. Next, the wave propagation moves downward and leftward, coming to the anterior and lateral walls. Later on, a stimulation of the remaining part of the left ventricle free wall is observed, and isochrones wander to the heart bottom. Finally, after about 80 ms from the beginning, a delayed stimulation wave reaches the right ventricle, passing around the blocked area and spreading through terminal fibres within right ventricle. In the both examined groups no significant differences in relation to isochrones distribution were observed, therefore the averaged VAT maps were assumed as a reference pattern for the given groups. A pattern of VAT maps distribution and values of ventricular activation time can be useful in the further investigations concerning an analysis of wave propagation in bundle branch blocks.

[Heart activation course on isochrone maps in normal subjects]. / Przebieg pobudzenia w sercu na mapach izochronowych u ludzi zdrowych.

Body surface potential mapping (BSPM) is a method providing a noninvasive assessment of the changes ongoing in the electric field of the heart. In the present study, the weakly recognized kind of the surface maps--isochrone maps that reflect in the best manner a pathway of the depolarization front propagation within the heart conduction system. BSPM was obtained using a HPM-7100 Fukuda Denshi system, which enables collecting a synchronic electrocardiographic recordings from 87 electrodes in the cylindrical system. The study population constituted 30 healthy subjects (15 females and 15 males) with the mean age of 23.9 +/- 4.56 years. The considered electrocardiogram from the all subjects appeared to be within the normative range. In order to obtain a pattern reflecting a depolarization trajectory in the human heart, the ventricular activation time maps (VAT), on the plane and superficial, were constructed with the own software. On the basis of the VAT maps obtained from the examined group, the group-mean VAT map for the normal subjects was created. Isochrone maps render much more information about heart activation spread than the standard 12-leads electrocardiography system. Using isochrone maps, one can monitor precisely a depolarization trajectory in the individual heart portions. The values and distribution of isochrones determine a velocity of activation propagation within the heart conduction system. Analysis of the isochrone maps collected in the normal subjects confirmed the activation pathway of the ventricles, starting from atrioventricular junction, via His bundle and its branches and finally to the myocardium through Purkinje fibres. In the examined group, no significant differences in relation to the isochrones distribution were found, therefore the group-mean VAT map was assumed as a reference pattern. The pattern of distribution and values of VAT map established for the normal subjects can be used in the further investigations concerning a diagnosis of the heart conduction system disturbances.

[Patterns of body surface isointegral maps for anteroseptal and inferior myocardial infarction]. / Wzory izointegralnych map powierzchniowych w zawale przednio-przegrodowym i sciany dolnej miesnia sercowego.

A goal of the present paper was to determine the patterns of the QRS isointegral maps for the two location of myocardial infarction: anteroseptal (aMI) and inferior (iMI), using a method of body surface potential mapping (BSPM) with a 87-electrode Fukuda Denshi system. The maps were recorded in the two groups of the patients with previous (6-12 month earlier), clinically documented, Q-wave myocardial infarction. The examined group comprised 36 patients with aMI and 32 patients with iMI. The analysis concerned the isointegral maps of the assigned seven time intervals within the QRS complex (the A-G maps), rendering the patterns of positive and negative potential distribution, likewise the group-mean values of minima and maxima for each of the analyzed maps. The increased area of negative potential, as compared with the corresponding control maps, was observed in the maps of the A, B and D intervals in the aMI group. Contrary, in the iMI group a pathological negative potential was found only in the E maps (the second half of the QRS complex). The comparative analysis of the potential extremes revealed in the aMI group the significantly more negative minima in the A, B, D and E maps and lower maxima in the A and B maps. However, in the iMI group the only statistically significant difference were the lower minima for the E maps. The investigations resulted in creating the patterns of the pathological distribution of the negative potential and the minimum values in the isointegral QRS maps, which are specific for the anteroseptal and inferior myocardial infarction.

Inactivation of the cyclin-dependent kinase inhibitor 2A (CDKN2A) gene in squamous cell carcinoma of the larynx.

Defects in the system controlling the cell cycle can lead an increased proliferation of cancer cells. The aim of our study was to analyze the relationship between genetic changes leading to inactivation of the CDKN2A gene and subsequent alteration of protein expression in squamous cell cancer of the larynx (SCCL) in connection with the clinical and histopathological course of the disease. Analysis was carried out on DNA isolated from the blood and primary larynx cancer cells of 62 patients. To investigate loss of heterozygosity (LOH), PCR fragment analysis was applied. The size and quantity of fluorescent PCR products were evaluated in an automated sequencer. Specific chemical methylation with sodium bisulfite in a sequential PCR reaction (MSP) was applied to analyze promoter methylation. Cancer tissue sections served to determine the level of protein expression with immunohistochemical (IHC) staining and commercial antibodies. LOH at the CDKN2A locus was observed in 55.35% of the informative cases. Aberrant methylation was found in 37.5% and a decreased level of protein expression observed in 45% of all informative cases. Whenever P16 expression was decreased, LOH and promoter hypermethylation at CDKN2A were observed with a frequency of 73.33% and 80.95%, respectively (Fisher's test, P<0.005). Sixty-nine percent of G3 tumors had at least one genetic alteration at CDKN2A, compared with 40.9% of G1 cancers. The results indicate that CDKN2A inactivation played a significant role in the development of squamous cell carcinoma of the larynx.

Correlation among loss of heterozygosity, promoter methylation and protein expression of MLH1 in larynx cancer.

Extensive molecular studies in development of the squamous cell carcinoma of larynx (SCCL) indicated the involvement of a variety of genes including the MLH1. To search for possible mechanism leading to MLH1 silencing in SCCL we studied LOH and promoter methylation in a homogeneous set of 62 larynx cancers. Then we evaluated immunohistochemically the MLH1 expression for 51 tumor specimens. Further, the results were correlated with microsatellite instability and subsequently with the clinical course of the disease. LOH at the MLH1 locus and aberrant methylation of its promoter were found in 47.9 and in 22.6% of tumors, respectively. A decreased expression was observed in 27.5% of the cases. MSI analysis of tumor DNA showed a microsatellite stable phenotype in 59 cases (95.2%). From our study it can be concluded that: i) molecular alterations of MLH1 play an important role in SSCL development, ii) both LOH and aberrant methylation contribute to the MLH1 inactivation in SCCL and are associated with a less advanced stage of differentiation of larynx tumors, iii) MLH1 inactivation does not lead to MSI in larynx cancer and MSI may not contribute to the development of SCCL.

[Body surface heart potential mapping in the limited lead system]. / Mapy potencjalu powierzchniowego serca w systemie o ograniczonej liczbie elektrod.

A goal of the presented study was to analyze and assess the information collected in the assigned electrocardiographic (ECG) arrangement, constituting a "transition" between the two systems of which one is a 87-lead cylindrical system, and the second one is a 30-lead spherical system. The transient 30-electrode arrangement has been selected from the 87-lead ECG network with the arbitrarily assigned electrodes location, which corresponded to the spherical network called "diamentoid". A subject of the visual inspection and analysis were isopotential and isointegral maps created in the three following lead systems: "total", 87-lead cylindrical system; "transient", 30-lead (limited lead) system, and 30-lead spherical system derived from the latter as a result of the diamentoid transformation. The performed comparisons were focused on determining the similarities and differences between the maps gained from the "full" and "limited" lead systems. The maps representing the entire cardiac cycle, constructed on the base of the ECG recordings obtained from the 53 patients, were assessed. The maps, covering the complex QRS divided in the eight portions, were subjected to the detailed analysis. As the result of the comparative analysis of the body surface maps generated in the given three lead systems, it could be concluded that isopotential and isointegral maps from the both 30-lead systems are capable to retain the significant information concerning the features of potentials distribution, as compared with the data provided by the 87-lead system.

[Ventricular activation time maps in health and after myocardial infarction registered in spherical system]. / Mapy czasu aktywacji komór dla ludzi zdrowych i pacjentów po zawale serca rejestrowanych w systemie sferycznym.

The present paper concerns the results of the examinations on Ventricular Activation Time distribution. The registrations were performed using the 30-electrode network connected to from the diamentoid scheme giving the sphere system, in the centre of which the heart is located. The potentials for one ECG cycle were measured at every electrode. The created computer program changed the spheric recordings into the plane development which resulted in the 30 ECG recordings located under the particular electrode. Using these values the activation time was determined for every registration point. On that basis, the isochronic map for the patient is created. The ECG tracings were recorded in 48 healthy subjects, treated as the control group, and in the 96 patients with the previous myocardial infarction varying in location and extension. The obtained maps were compared both within and between the examined groups. For the normal subjects, the isochrone distributions are similar. The lines are arranged according to the physiological activity propagation through the myocardium. The quite different distribution was observed on the isochrone maps obtained from the patients with myocardial infarction, as compared with the maps from the control group. On the basis of the specific isochrone distribution, the exact location and can be identified. The patterns for the given location of the myocardial infarction are significant similarity--the possible differences concern only the foci extensions.