Relationship between Depressive Symptoms and Weather Conditions.

Background: Weather is a well-known factor worldwide in psychiatric problems such as depression, with the elderly and females being particularly susceptible. The aim of this study was to detect associations between the risk of depressive symptoms (DS) and weather variables. Methods: 6937 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study during 2006−2008. To assess the risk of DS, a multivariate logistic model was created with predictors such as socio-demographic factors, health behaviors, and weather variables. Results: DS were found in 23.4% of the respondents, in 15.6% of males and in 29.9% in females. A higher risk of DS (by 25%) was associated with November−December, a rising wind speed, and relative humidity (RH) < 94% and snowfall during the cold period occurring 2 days before the survey. A higher air temperature (>14.2 °C) predominant during May−September had a protective impact. A higher risk of DS in males was associated with lower atmospheric pressure (<1009 hPa) 2 days before. Females were more sensitive to the monthly variation, snowfall, and RH. Conclusions: The findings of our study suggest that some levels of weather variables have a statistically significant effect on DS.

Lifestyle factors and psychological well-being: 10-year follow-up study in Lithuanian urban population.

BACKGROUND: Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population. METHODS: In the baseline survey (2006 to 2008), 7115 men and women 45-72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis. RESULTS: After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p < 0.05) compared to less frequent consumption of such food groups. Dose-response relationship between increasing number of healthy lifestyle factors and higher PWB was determined both in men and women. CONCLUSIONS: Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.

The associations of geomagnetic storms, fast solar wind, and stream interaction regions with cardiovascular characteristic in patients with acute coronary syndrome.

It is shown the statistical associations between space weather pattern and humans' cardiovascular system. We investigated the association between space weather events and cardiovascular characteristics of 4076 randomly selected patients with acute coronary syndrome (ACS) who were admitted for inpatient treatment in Kaunas city, Lithuania during 2000-2005. We hypothesized that days of the space weather events, 1-3 days after, and the period between two events, named as intersection days (1-3 days after the event, which coincided with 1-3 days before the event), might be associated with patients' cardiovascular characteristics. The multivariate logistic regression was applied, and the patients' risk was evaluated by odds ratio (OR), adjusting for age, sex, smoking status, the day of the week, and seasonality. During the intersection days of geomagnetic storms (GS), the risk of ACS increases in obese patients (OR=1.72, p = 0.008). The risk of ventricular fibrillation during admission was associated with stream interaction region (SIR) with a lag of 0-3 days (OR=1.44, p = 0.049) The risk of ACS in patients with chronic atrial fibrillation was associated with fast solar wind (FSW) (≥600 km/s) (lag 0-3 days, OR=1.39, p = 0.030) and with days of solar proton event (lag 0-3) going in conjunction with SIR (lag 0-3) (OR=2.06, p = 0.021). During days which were not assigned as GS with a lag of (-3 to 3) days, FSW (lag 0-3) was associated with the risk of ACS in patients with renal disease (OR=1.71, p = 0.008) and days of SIR - with the risk in patients with pulmonary disease (OR=1.53, p = 0.021). A SIR event, days between two space weather events, and FSW without GS may be associated with a risk to human health.

Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986-2015.

BACKGROUND: This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40-64 years. METHODS: Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. RESULTS: From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. CONCLUSIONS: the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.

Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease.

OBJECTIVE: The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multivessel disease (MVD). MATERIALS AND METHODS: A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140mmHg) were assigned to the first group (n=58); with normal ASBP (<140mmHg), to the second group (n=46); with increased myocardial mass index (MMI) (>100g/m(2)), to the third group (n=70); and with normal MMI (<100g/m(2)), to the fourth group (n=34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months. RESULTS: There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%±8.25% vs. 46.8%±7.13%, P=0.018). CONCLUSION: Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.

Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting.

AIMS: The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. STATISTICAL ANALYSIS USED: SPSS software for Windows, version 13.0. The t-test or the χ(2)-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. RESULTS: During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4-2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22-8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2-3.89; P = 0.01), and the summed stress score (SSS) of ≥4 (HR: 1.87; 95% CI: 1.02-3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06-1.48; P = 0.034). CONCLUSIONS: The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE.

The effect of solar-geomagnetic activity during and after admission on survival in patients with acute coronary syndromes.

A number of studies have established the effects of solar-geomagnetic activity on the human cardio-vascular system. It is plausible that the heliophysical conditions existing during and after hospital admission may affect survival in patients with acute coronary syndromes (ACS). We analyzed data from 1,413 ACS patients who were admitted to the Hospital of Kaunas University of Medicine, Lithuania, and who survived for more than 4 days. We evaluated the associations between active-stormy geomagnetic activity (GMA), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after admission, and 2-year survival, based on Cox's proportional-hazards model, controlling for clinical data. After adjustment for clinical variables, active-stormy GMA on the 2nd day after admission was associated with an increased (by 1.58 times) hazard ratio (HR) of cardiovascular death (HR=1.58, 95 % CI 1.07-2.32). For women, geomagnetic storm (GS) 2 days after SPE occurred 1 day after admission increased the HR by 3.91 times (HR=3.91, 95 % CI 1.31-11.7); active-stormy GMA during the 2nd-3rd day after admission increased the HR by over 2.5 times (HR=2.66, 95 % CI 1.40-5.03). In patients aged over 70 years, GS occurring 1 day before or 2 days after admission, increased the HR by 2.5 times, compared to quiet days; GS in conjunction with SF on the previous day, nearly tripled the HR (HR=3.08, 95 % CI 1.32-7.20). These findings suggest that the heliophysical conditions before or after the admission affect the hazard ratio of lethal outcome; adjusting for clinical variables, these effects were stronger for women and older patients.

The impact of myocardial revascularization after acute coronary syndromes on one-year cardiovascular mortality.

UNLABELLED: The aim of this observational study was to evaluate the impact of myocardial revascularization performed after acute coronary syndromes on one-year cardiovascular mortality. MATERIAL AND METHODS: The study population comprised 1226 consecutive patients who were admitted to the Clinic of Cardiology in 2005 because of acute coronary syndromes with significant (≥70%) coronary artery stenoses. The relationship between myocardial revascularization and one-year cardiovascular mortality was evaluated by applying multivariable logistic regression. Cardiovascular mortality was evaluated using the Kaplan-Meier method. RESULTS: Of all the patients included into the study, 540 had Q-wave myocardial infarction, 339 patients had non-Q-wave myocardial infarction, and 347 patients were treated for unstable angina pectoris. During hospitalization, 496 patients underwent percutaneous transluminal coronary angioplasty, 373 patients underwent coronary artery bypass grafting within 60 days following acute coronary syndromes, and 357 patients received pharmacological treatment alone. During one-year follow-up, 105 cases of cardiovascular death were registered. The one-year cardiovascular mortality was significantly lower in patients who underwent percutaneous transluminal coronary angioplasty or coronary artery bypass grafting comparing with those patients who received only pharmacotherapy (5.4% and 7.8% vs. 14.3%, P<0.05). Multivariate logistic regression analysis revealed that myocardial revascularization independently reduced one-year cardiovascular mortality (adjusted odds ratio for percutaneous transluminal coronary angioplasty, 0.304; 95% CI, 0.18 to 0.53; P<0.001, and coronary artery bypass grafting, 0.540; 95% CI, 0.32 to 0.90; P=0.018) in patients who were admitted because of acute coronary syndromes. CONCLUSIONS: Myocardial revascularization performed after acute coronary syndromes was significantly associated with the reduction of cardiovascular mortality within one-year period independently of clinical variables.

[Data of coronary angiography and normal stress myocardial perfusion scintigraphy]. / Normali kruvio miokardo perfuzija ir vainikiniu arteriju bukle.

OBJECTIVE: To determine informativity of clinical variables in predicting significant coronary artery disease in patients with chest pain and normal stress myocardial perfusion scintigraphy. MATERIAL AND METHODS: This study was a retrospective analysis of data of coronary angiography performed in 84 patients with chest pain and normal stress myocardial perfusion scintigraphy during 2000-2007. Single-photon emission computed tomography was performed following a one-day protocol (stress-rest). A 5-point (0-4) scoring system in a 20-segment model was used for interpretation of results. Myocardial perfusion was considered normal if the sum of stress scores was 0 to 3. RESULTS: High pretest probability and informative exercise-terminating criteria were documented in 25% and 45.2% of patients, respectively. Significant coronary artery disease (stenosis ≥ 75%) was determined in 26 (31%) patients with normal myocardial perfusion scintigraphy: 15 (17.9%) patients had coronary artery disease of a single vessel, 5 (6%) of two vessels, and 6 (7.1%) of three vessels. Univariate logistic regression analysis showed that patients with typical angina and high pretest probability were more likely to have significant stenosis of one to three arteries (odds ratios, 3.8; P=0.008 and 3.43; P=0.023, respectively). Three-vessel disease was more often documented in patients with typical angina (odds ratio, 11.2; P=0.009), high pretest probability (odds ratio, 7.93; P=0.018), and signs of ischemia during exercise test (odds ratio, 6.4; P=0.037). CONCLUSION: Patients with typical angina, high pretest probability, and signs of ischemia during exercise test have an increased probability of having significant coronary artery disease despite normal stress myocardial perfusion scintigraphy; therefore, this group of patients should undergo coronary angiography.

[Associations between acute heart failure and cardiovascular outcomes]. / Uminio sirdies nepakankamumo sasajos su sirdies ir kraujagysliu sistemos ligu baigtimis.

UNLABELLED: The aim of the study was to determine associations of acute coronary syndrome and acute heart failure with mortality from cardiovascular causes during hospitalization and mortality from cardiovascular causes and chronic heart failure during one-year period. MATERIAL AND METHODS: A total of 1554 consecutive patients with discharge diagnosis of acute coronary syndrome, treated at the Clinic of Cardiology, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005, were prospectively enrolled into the study. For the assessment of patients' status, data from the Cardiac Center Registry database were used. Patients were followed up for one year from admission to hospital. RESULTS: Acute heart failure was diagnosed in 32.3% of patients during hospitalization, and chronic heart failure was diagnosed in 17% during a one-year follow-up period. Myocardial revascularization was performed in 70.8% of patients with coronary artery stenosis of ≥70%. After one year, chronic heart failure was documented in 1039 patients, and it was almost three times more frequent in patients who had acute heart failure at diagnosis of acute coronary syndrome than in patients without acute coronary syndrome during hospitalization (31.4% vs. 11.6%; P<0.05). Death from cardiovascular causes occurred more frequently in patients with acute heart failure than without it during both in-hospital and out-of-hospital periods (11.5% vs. 1.9%, P<0.001; 7.7% vs. 2.3%, P<0.001). CONCLUSION: In the presence of acute coronary syndrome, diagnosed acute heart failure significantly increases the frequency of chronic heart failure during one-year period and mortality rate from cardiovascular diseases during hospitalization and one-year period.

Evaluation of needs for therapeutic monitoring of digoxin in a tertiary hospital.

OBJECTIVES: To collect the data about the consumption of digoxin, evaluate the tendencies towards usage of this drug during 2004-2007, and to find departments, which cover the main part of digoxin consumption in a tertiary hospital. To evaluate the intensity of serum digoxin concentration measurements during 2005-2007. MATERIAL AND METHODS: Our study was carried out in a tertiary hospital with 2600 beds and 63 departments. Consumption of digoxin is expressed in defined daily doses per 100 occupied beds daily during 2004-2007. All serum concentration measurements in 2005-2007 were evaluated. RESULTS: The main consumers of digoxin in 2007 were the Units of Endocrinology, Pulmonology and Immunology, Cardiology II, Neurosurgical Reanimation and Intensive Care, Neurology, Eye Disorders I, Intensive Care Unit of Cardiology; they consumed 51.05% of total digoxin. In total, 58 digoxin measurements were performed in 2005, 89 in 2006, and 64 in 2007. The intensity of serum concentration measurements for digoxin is 1/147 (one measurement for 147 defined daily doses) in 2005, 1/89 in 2006, and 1/107 in 2007. These results show that intensity of serum digoxin concentration measurements is low. CONCLUSIONS: Twenty-two out of the 63 departments cover 90% of digoxin consumption per year. The changes in digoxin consumption were not statistically significantly different in 2004-2007. There was a tendency towards an increase in serum digoxin concentration measurements during the 3-year period. Digoxin concentration outside therapeutic ranges was established in about half of all cases in 2005-2006, but there was an increase in normal serum concentration in 2007.

The prevalence of the metabolic syndrome components and their combinations in men and women with acute ischemic syndromes.

During the last decade, it has been shown that the metabolic syndrome and its different components--arterial hypertension (AH), abdominal obesity (AO), diabetes mellitus (DM), atherogenic hypertriglyceridemia (HTG), and/or low concentration of high-density lipoprotein cholesterol (HDL-C))--increase the risk of cardiovascular diseases. There is increasing evidence that the incidence of the metabolic syndrome and the distribution of its components in combinations in the general male and female population differ. The aim of our study was to determine the incidence of the metabolic syndrome in men and women with acute ischemic syndromes and to evaluate the distribution of the metabolic syndrome component combinations in the presence of the metabolic syndrome. Contingent and methods. The study included 2756 patients (1670 males and 1086 females) with acute ischemic syndromes (1997 with myocardial infarction and 759 with unstable angina pectoris), in whom all five components of the metabolic syndrome were assessed. Women were significantly older than men (68.1+/-9.5 vs. 60.2+/-11.8 years, P<0.001). The metabolic syndrome was found (according to modified NCEP III) in 1641 (59.5%) patients (in 70.2% of females and in 52.6% of males, P<0.001). The most common components in both men and women were AH and AO (94.0% vs. 95.9% and 86.4% vs. 84.5%, respectively). HTG was significantly more common in men than in women (80.0% vs. 73.0%, P<0.001), while decreased HDL-C concentration was more common in women (82.8% and 59.2%, P<0.001). The DM component, detected in more than one-third of patients with acute ischemic syndromes, was significantly more common in women than in men (39.2% vs. 33.1%, P<0.05). Combinations of three components were significantly more common in men than in women, while combinations of four-five components were more common in women (55.6% vs. 41.4%, P<0.001; and 58.6% vs. 44.4%, P<0.01). The most common combination of three components in men was AH+AO+HTG and in women--AH+AO+low HDL-C; the most common combination of four components in both men and women was AH+AO+HTG+low HDL-C. CONCLUSION. In the metabolic syndrome, the differences between the components of atherogenic dyslipidemia in patients with acute ischemic syndromes were related to the patients' gender: men significantly more frequently had increased TG concentration and women--decreased HDL-C concentration; this is the problem to be addressed in further studies of dyslipidemia.

[Prevalence of metabolic syndrome components in patients with acute coronary syndromes]. / Metabolinio sindromo komponentu daznis tarp susirgusiuju uminiais iseminiais sindromais.

OBJECTIVE: Many studies report that the components of the metabolic syndrome--arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia--are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes. METHODS AND RESULTS: The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3+/-11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (> or =6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components. CONCLUSION: More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome.

The risk of cardiovascular death following the first acute ischaemic syndrome: experience in Kaunas between 1997 and 2001.

UNLABELLED: The aim of our study was twofold: initially to investigate the effects of the informative value of the variables of the acute period on the risk of cardiovascular death during the long-term period following the first acute coronary syndrome, and then to determine the long-term survival rate in different risk groups. METHODS: The prospective five-year observational study included 732 patients with acute coronary syndrome who had survived the hospital period. Employing multivariable Cox's proportional-hazard analysis, the most informative variables were selected, the risk score index was calculated, the risk groups for the prediction of cardiovascular death were identified, long-term survival (4.5 +/- 2.1 years) in different risk groups was determined and internal validation of the model was performed. RESULTS: During the observational period, 84 patients (11.5%) died due to cardiovascular causes. Cox proportional-hazard models demonstrated that six variables had significant influence on long-term survival during the five-year period after an acute coronary syndrome. These variables were: age [1-5 points], the presence of pathologic Q wave in >2 ECG leads [2 points], Killip class II-IV [2-4 points], left ventricular ejection fraction <35% [2-4 points], proximal stenosis of coronary arteries [2-4 points], absence of myocardial revascularization in the acute period [2 points]. Three strata for risk of cardiovascular death were identified [0-5 points--14.1% patients, 6-10 points--62.6%, >10 points - 23.3%]. The probability of survival within the period of five years was found to be favourable for the majority of patients in the low- and medium-risk groups, while the number of such patients in the high-risk group was significantly lower [97.0% vs. 89.0% vs. 73.0%, P < 0.0000]. The difference in the survival probability was negligible in developmental and validation sets. CONCLUSION: The risk score derived from clinical variables of first acute coronary syndromes permits a reliable determination of risk for cardiovascular death as well as the prediction of long-term survival in different risk groups.

Prognostication of late left ventricular systolic dysfunction in patients with acute coronary syndrome during the acute period.

The aim of the study was to create the model of the combination of clinical and echocardiographic determinants during the acute period of acute coronary syndromes for the prognostication of the risk for left ventricular dysfunction after one year. We examined 565 patients with first-time acute coronary syndrome with no recurrence during one-year period. The studied group consisted of 496 patients, and the examined group--of 69 patients. All patients with acute coronary syndrome within the first three days underwent the evaluation of demographic, anamnesis, clinical indicators, risk factors for ischemic heart disease, ECG, and echocardiographic findings for the prognostication of the risk of left ventricular dysfunction after one year. Multiple logistic regression analysis was applied for the identification of independent determinants for the prognostication of left ventricular dysfunction, and three risk groups were identified. The prognostic informative value of the model was verified by comparing the incidence of left ventricular systolic dysfunction in risk groups after one year between the studied and the control groups. RESULTS. After one year, left ventricular systolic dysfunction (left ventricular ejection fraction <40%) in the presence of acute coronary syndrome remained in more than half (65.3%) of patients and returned to normal (left ventricular ejection fraction > or =40%) in one-third of patients (34.7%). Left ventricular systolic function that was normal during the acute period of coronary syndrome remained such in the majority (80.9%) of patients after one year, whereas one-fifth (19.1%) of patients developed left ventricular systolic dysfunction. The mathematical model for the prognostication of systolic dysfunction after one year was composed of the determinants of acute coronary syndrome: left ventricular ejection fraction <40%, anterior localization of Q-wave myocardial infarction, Killip class 3-4, left ventricular pseudo-normal or restrictive diastolic function, and frequent ventricular extrasystoles. The application of our model in the prognostication of late left ventricular systolic dysfunction during the acute period of coronary syndrome showed that the model was reliable, since after one year, the prognosticated left ventricular systolic dysfunction was determined in the majority (84.3%) of patients. The designed mathematical model is simple and is based on standard clinical and echocardiographic findings, and the scoring system allows for the prognostication of the risk for late left ventricular systolic dysfunction in any individual patient. The prognostication of the risk for late left ventricular systolic dysfunction during the acute period of coronary syndrome may help in the planning of treatment and outpatient care in patients with acute coronary syndrome.

[Secondary prevention of ischemic heart disease: pharmacological treatment after myocardial infarction according to follow-up protocol]. / Antrine isemines sirdies ligos profilaktika persirgus miokardo infarktu (medikamentinio gydymo ivertinimas remiantis anketines apklausos duomenimis).

UNLABELLED: The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction. MATERIAL AND METHODS: We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8+/-3.2 months after myocardial infarction were collected by letter with questionnaire. RESULTS: Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely--two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Beta-adrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6-10.3%). CONCLUSIONS: These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction.

[Admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus]. / Susirgusiuju miokardo infarktu, be cukrinio diabeto anamnezeje, hiperglikemijos daznis hospitalizavus ir israsant is stacionaro.

UNLABELLED: The objective of this study was to determine frequency of admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus. METHODS AND RESULTS: Data on 1522 patients with acute myocardial infarction and no previous history of diabetes mellitus were analyzed. Before discharge from hospital, standardized oral glucose tolerance test was performed in 197 patients with admission hyperglycemia. RESULTS: Admission hyperglycemia (> or =6.1 mmol/L) was determined in half of the patients with acute myocardial infarction: glucose concentration of 6.1-6.99 mmol/L was in 21.5% and > or =7.0 mmol/L in 30.1% of the patients. By using glucose tolerance test, normal glucose metabolism was noted in 57.9% of the patients with admission hyperglycemia; abnormal glucose tolerance was diagnosed newly in more than one-third and glucose concentration of > or =11.1 mmol/L in 10.1% of the patients. CONCLUSIONS: Abnormal glucose tolerance is a frequent feature in nondiabetic patients with admission hyperglycemia during acute myocardial infarction, and glucose tolerance test should be considered in all patients with ischemic heart disease for early modification of this risk factor.

[Evaluation of clinical parameters and myocardial perfusion scintigraphy findings in patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test]. / Klinikiniu rodmenu ir miokardo perfuzijos sutrikimu ivertinimas pacientams, kuriems itariama isemine sirdies liga, pakitusi ramybes elektrokardiograma ir neinformatyvus veloergometrijos tyrimas.

UNLABELLED: The aim of this work was to estimate the impact of clinical variables on predicting stress myocardial perfusion abnormalities in patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test. MATERIAL AND METHODS: The clinical variables and stress myocardial perfusion data were analyzed in 370 patients (157 males and 213 females) with suspected coronary artery disease and abnormal resting electrocardiogram. All patients underwent (99m)Tc-methoxyisobutylisonitrile (MIBI) scintigraphy following a one-day protocol (stress-rest). The bicycle exercise test was considered noninterpretable when the age-predicted peak heart rate was not achieved, and ischemic signs were not detected. RESULTS: One hundred sixty (43.2%) patients had noninterpretable bicycle exercise test. Pathological stress myocardial perfusion defects (reversible and fixed) were more often present in patients with noninterpretable than in patients with informative exercise test (63.1 and 50.0%, respectively, p<0.01). Univariate analysis showed that reversible perfusion defects were more frequent in men than in women (p<0.00001, odds ratio 9.6), in patients with pre-existing left bundle-branch block (p<0.02, odds ratio 3.4), and in cases when sufficient working capacity (> or =150 W) was achieved (p<0.05, odds ratio 2.1). CONCLUSION: The myocardial perfusion defects were registered in 63.1% of patients with suspected coronary artery disease, abnormal resting electrocardiogram, and noninterpretable exercise test. The probability of reversible perfusion defects was higher in male patients, in patients with pre-existing left bundle-branch block and with sufficient working capacity (> or =150 W).

Trends in the consumption of antidepressant drugs in Lithuania in 2002-2004.

OBJECTIVE: To evaluate trends in the use of antidepressant drugs in Lithuania between 2002 and 2004 and to perform cost-minimization and reference price analysis enabling more rational use of financial resources of national health system. MATERIAL AND METHODS: The data on sales of antidepressant drugs in Lithuanian over a 3-year period (2002-2004) were obtained from IMS Health Inc. database. Data were calculated by defined daily dose (DDD) methodology and expressed in DDDs per 1000 inhabitants per day. DU90% was used as the quality indicator of the drug prescribing. The pharmacoeconomic analysis of antidepressant drugs was performed by cost-minimization and reference price methodology. RESULTS: The consumption of antidepressants in Lithuanian increased by 30.55% over a 3-year period (2002-2004) reaching the value of 10.00 DDDs/1000 inhabitants/day. Since 2002, the proportion of use of selective serotonin reuptake inhibitors has increased by 27.82%, and the use of tricyclic antidepressants has declined by 10.78%, while the use of other (newer) antidepressant drugs expanded almost three times. The expenditures of antidepressant drugs have reached 26 million Lt in 2004, of which 68.15% were costs for selective serotonin reuptake inhibitors. Choosing the second lowest price in different antidepressant drug class, it is estimated the possible savings of 4.34 million Lt lowering the total expenses by 16.5% (1 euro=3.4528 Lt). CONCLUSIONS: The findings suggest that the use of total antidepressant drugs continues to increase because of the increased use of selective serotonin reuptake inhibitors and other (newer) antidepressant drugs. In comparison with the data in other countries, the consumption of antidepressant drugs in Lithuania is low.

[Breastfeeding and medications]. / Zindymas ir medikamentai.

Breastfeeding is the most healthful method of feeding neonates and infants. In 2001 about 98% of new mothers in Lithuania started breastfeeding their neonates. One-third of nursing women (34%) discontinued breastfeeding at the time when infant reached the age of 3 months. About 56% of women breastfed their infants longer than 4 months. Only 3-6% of nursing women discontinued breastfeeding after the fourth month. Discontinuation of breastfeeding in 21-23% of all cases was directly or indirectly associated with use of medications. Such data suggest that there is a lack of information often leading physicians to advise mothers to discontinue breastfeeding because of medication use. The aim of this article was to survey the situation about classification of drugs used during breastfeeding and factors influencing drug transfer into milk in order to give more information for physician concerning the use of medication during breastfeeding. In this review, a short description of main pharmacokinetic characteristics, influencing drug transfer into milk; information on the classification of drugs used during breastfeeding; some considerations on drug safety and possible adverse effects of medications on breastfed infant; the list of drugs preferred for nursing women are presented.