Correlation of B type natriuretic peptides with clinical and echocardiographic parameters in heterogeneous population of patients with symptoms suggestive of heart failure.

PURPOSE: NT-proBNP and BNP concentrations in CHF correlate with NYHA class and LVEE Little research has been conducted to compare the clinical performance of these two natriuretic peptides in heterogeneous CHF population. Purpose: to evaluate and compare the clinical performance of NT-proBNP and BNP in heterogeneous group of CHF patients on the basis of these peptides' correlation with NYHA class, LVEF and WMI measured by echocardiography. MATERIAL AND METHODS: Consecutive patients admitted for suspected of CHE Blood samples were drawn for NT-proBNP, BNP, creatinine and echocardiography was performed. RESULTS: 71 patients were included. CHF was diagnosed in 53. Sensitivity of NT-proBNP and BNP in diagnosing CHF was 83% and 94% respectively (P = 0.079). Levels of both peptides correlated equally well with NYHA class (R = 0.537, p < 0.001; R = 0.473, P < 0.001), LVEF (R = -0.623, p < 0.001; R = -0.601, P < 0.001) and WMI (R = 0.590, P < 0.001; R = 0.527, P = 0.001). Creatinine correlated with both peptides, age correlated with NT-proBNP. No difference between sexes was found in both peptides' concentrations. In multivariate analysis independent determinants of BNP were LVEF, presence of valvular disease and NYHA class. In case of NT-proBNP age and creatinine also displayed independent influence. CONCLUSIONS: NT-proBNP and BNP show good sensitivity in detecting CHE Levels of both peptides correlate equally well with clinical and echocardiographic parameters of CHF, which makes them equally adequate in biochemical staging of CHF's severity regardless of its underlying cause. Levels of natriutretic peptides reflect contractile dysfunction, valvular disease and clinical condition. Age and creatinine concentration but not patients' sex should additionally be considered when measuring NT-proBNP.

[Permanent heart pacing in treatment of cardioinhibitory vasovagal syncope (case report)]. / Stala stymulacja serca w leczeniu postaci kardiodepresyjnej zespolu wazowagalnego (opis przypadku).

Vasovagal syncope is a complex syndrome in which specific methods of treatment rarely are related to clinical success. Since it turned out that some patients with neurocardiogenic syncope were resistant to offered pharmacotherapy, cardiac pacing has been used as the alternative way of long-term therapy. Successive studies, which have estimated clinical efficacy of permanent cardiac pacing, indicate that such method of treatment may reduce symptoms revealed by vasovagal reflex. Nevertheless the optimal pacing mode has not been established yet. It is known that single chamber VVI pacing is not a good and effective method whereas dual chamber DDI pacing with rate hysteresis seems to be very promising in treatment of people suffering from malignant cardioinhibitory vasovagal syncope. DDD pacing with rate drop response, search and scan functions recently has been available to these patients. The results of the North American Vasovagal Pacemaker Study, as well as some casuistic observations referring to patients with vasovagal syndrome, show very high clinical efficacy of dual chamber pacing with mentioned new functions. We present a case of patient with cardioinhibitory vasovagal syncope who was successfully treated by permanent DDD pacing with search and scan hysteresis.

[Frequency of paroxysmal atrial fibrillation and parameters of averaged atrial signal]. / Czestosc napadów migotania przedsionków a parametry usrednionego sygnalu przedsionkowego.

The aim of the study was to evaluate the importance of time and frequency domain analysis of P-wave signal averaging, left atrium size measured echocardiographically and time of P.-wave assessed in II lead of standard ECG in patients with different frequency of atrial fibrillation events. The material consisted of 110 pts (81 men and 29 women), mean age 60.44 +/- 10.73 with atrial fibrillation events concomitant coronary heart disease and/or primary hypertension documented in standard ECG or Holter monitoring. The positive correlation, statistically significant between the frequency of atrial fibrillation events and the time of filtered P-wave vector, the time of filtered P-wave in X, Y, Z leads and differences between times of filtered P-wave vector and times of P-wave in II ECG lead was confirmed. Additionally the negative correlation, statistically significant between frequency of atrial fibrillation events and RMS10, RMS20 and RMS30 was confirmed. There was no correlation between frequency analysis of P-wave averaging or left size and frequency of atrial fibrillation events.

[The influence of amiodarone on results of the signal-averaged electrocardiogram]. / Wplyw amiodaronu na wyniki elektrokardiogramu wysokiego wzmocnienia.

The aim of this study was to assess if amiodarone hydrochloride administered intravenously influenced signal-averaged electrocardiogram and if this effect can be used in diagnosing patients prone to sustained ventricular tachycardia (sVT). Two hundred thirty seven patients were divided into 3 groups: group K--58 patients with no apparent heart disease, group W--121 patients with remote myocardial infarction and group C-58 patients with remote myocardial infarction and at least one episode of sVT. Signal-averaged electrocardiograms (SAECG) were assessed in time domain (QRS, LPD, RMS40) and frequency domain analysis logarhythmically (40 D, 60 A) and linearly [formula: see text] for windows lasting 120 and 140 ms, and starting 20, 40, 80 ms before the end and 60 ms after the beginning of QRS complex. Amiodarone hydrochloride increased frequency of late potentials (LP) in all groups especially in group C (K 5.2%-9.1%, W 33.9%-41.4%, C 75.9% -90.9%. Amiodarone hydrochloride prolonged total activation time--QRS (K -4.27 ms, W -6.06 ms, C -5.82 ms), time of low amplitude signals LPD (K -2.64 ms, W -2.87 ms, C -5.39 ms) and decreased the amplitude of RMS40 (K -2.12 mV, W -4.67 mV, C -5.0 mV). In group C the influence of amiodarone hydrochloride was found the strongest in the terminal part of the QRS complex whereas its influence on total activation time of QRS complex was weaker. We concluded that in patients prone to sVT amiodarone hydrochloride most strongly influenced the terminal part of QRS complex which suggested predominant influence on the zone of delayed conduction and amiodarone hydrochloride non significantly influenced on the results of frequency domain analysis.