Renal Artery Denervation Due to Refractory Hypertension in a Patient After Kidney Transplantation-3 Years of Observation: A Case Report.

INTRODUCTION: Hypertension is prevalent in most patients after renal transplantation, and it is the main factor contributing to cardiovascular diseases that cause death of a significant number of these patients. Up to 95% of patients after transplantation have hypertension, and among them are patients with refractory hypertension. Elevated blood pressure is one of the causes of deterioration of transplant function and may accelerate transplant loss. CASE REPORT: We present the first case in the world of a patient (who was 61 years old) in whom denervation of native renal arteries was performed after renal transplantation (2004). The patient was suffering from uncontrolled refractory hypertension. Antihypertensive therapy was used but the effect was not satisfactory. The patient received amlodipine, bisoprolol, clonidine, furosemide, and doxazosin in high doses. Clinical assessments with ambulatory blood pressure monitoring revealed a predominant blood pressure 149/96 with incidents of hypertensive crises. High blood pressure is a cardiovascular risk factor and it also has a significant influence on transplant failure, which was the reason for performing the denervation. The procedure was carried out through the femoral artery with the use of a 6F guiding catheter. During a 3-year observation, significant decreases in ambulatory blood pressure monitoring systolic and diastolic blood pressures were observed after the procedure (149/96 mm Hg vs 134/91 mm Hg before and after the denervation, respectively). There was a significant regression of left ventricle mass (577 g before denervation vs 470 g after 3 years). The functioning of the renal transplant became stable after 3 years of observation (38 mL/min before denervation and 38 mL/min after 3 years). CONCLUSIONS: The first case in the world of a renal transplant patient who had denervation of native renal arteries has demonstrated a positive effect in controlling blood pressure over a 3-year observation. Three years after denervation, a reduction of heart hypertrophy and stabilization of renal function were noted. The presented case shows that denervation of native renal arteries denervation may be successful and safe in kidney transplant recipients.

Renal Artery Denervation in Patient After Heart and Kidney Transplantation With Refractory Hypertension.

We describe the case of a 54-year-old patient after renal and heart transplantation in whom uncontrolled hypertension was diagnosed. Despite combined antihypertensive therapy, no significant therapeutic effect was achieved. Clinical assessment of ambulatory blood pressure monitoring (ABPM) revealed the ineffectiveness of a bisoprolol, nitrendypin, klonidyn, ramipryl, furosemide, and doxasosine combination used at high doses. High blood pressure levels with their effect on a hypertrophic transplanted heart (left ventricular mass 254 g) and poor renal graft function (39 mL/kg/min) posed an extremely high risk of future cardiovascular complications, and were the reason to perform a native renal arteries denervation. The procedure was carried out through the right femoral artery with the use of a 6F guiding catheter. During a 1-year observation, significant decreases in ABPM systolic and diastolic blood pressures were observed after the procedure (168/88 mm Hg vs 154/77 mm Hg, respectively). Moreover a significant regression of left ventricular mass (215 g/m(2)) and stable renal graft function were noted. The presented case shows that native renal arteries denervation may be successful and safe in kidney and heart transplant recipients. Moreover, during the 1-year follow-up, the reduction in blood pressure was followed by a reduction in transplanted heart hypertrophy, both leading to regression of cardiovascular risk for the patient.

Impact of the PPARGC1A Gly482Ser polymorphism on left ventricular structural and functional abnormalities in patients with hypertension.

The Gly482Ser polymorphism in the peroxisome proliferator-activated receptor gamma coactivator-1α (PPARGC1A) has been reported to contribute to the development of left ventricular (LV) hypertrophy. Little is known, however, about its possible impact on cardiac dysfunction. Enhanced myocardial fibrosis accompanying increased LV mass might represent a link with coexisting functional abnormalities. We investigated the association between the PPARGC1A Gly482Ser polymorphism and LV morphology and performance in essential hypertension, with special consideration of fibrosis intensity. A total of 205 hypertensive patients (60±8 years) underwent echocardiography with assessment of cardiac morphology, LV systolic (strain and strain rate) and diastolic function (peak early diastolic mitral flow velocity/peak late diastolic mitral flow velocity (E/A) ratio, peak early diastolic myocardial velocity (Em), and E/e' ratio (where e' is the peak early diastolic mitral annular velocity)), evaluation of serum procollagen type III amino-terminal propeptide (PIIINP) and procollagen type I carboxy-terminal propeptide (PICP)-markers of fibrosis and the PPARGC1A Gly482Ser genotyping. Subjects with the Ser-Ser genotype demonstrated more profound LV hypertrophy and diastolic function impairment, and higher PICP/PIIINP than the Ser-Gly and Gly-Gly groups. In multivariable analysis, the presence of the Ser-Ser allele was an independent correlate of E/e' (ß=0.17, P<0.02), Em (ß=-0.18, P<0.01) and LV mass index (ß=0.28, P<0.001). In conclusion, in hypertensive patients, the PPARGC1A Gly482Ser polymorphism is associated with LV hypertrophy and diastolic dysfunction, with the presence of the Ser-Ser allele promoting these abnormalities. One of the possible mechanisms mediating the adverse effect on diastolic performance might be a relative increase in the anabolism of rigid collagen type I over that of the more elastic collagen type III, as indicated by an increased ratio of PICP to PIIINP.

[Effect of digoxin on atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and cyclic 3', 5'-guanosine monophosphate (cGMP) in patients with chronic congestive heart failure]. / Wplyw digoksyny na stezenie przedsionkowego peptydu natriuretycznego, mózgowego peptydu natriuretycznego i cyklicznego 3', 5'-guanozynomonofosforanu u chorych na przewlekla, zastoinowa niewydolnosc serca.

UNLABELLED: Neurohumoral factors play important role in the pathogenesis of congestive heart failure (CHF) and digoxin (dig) is one of the most frequently used drugs in this condition. The aim of this study was to assess the effects of dig on atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and their "second messenger" cyclic 3',5'-guanosine monophosphate (cGMP). MATERIAL AND METHOD: The study group consisted of 25 patients (pts) aged 25-81 with CHF (NYHA II/III), 13 women and 12 men. Control group consisted of 10 healthy volunteers, 2 women and 8 men. The blood samples for evaluation of ANP, BNP and cGMP plasma level was taken at baseline conditions and 3 hours (h) after intravenous injection of 0.25 mg of dig. From the next day 0.25 mg dig was administrated orally for 6 days and plasma levels of ANP, BNP and cGMP were assessed on the 3rd and 6th day of treatment. Medium serum dig concentration on the 6th day was 0.98 ng/mL. RESULTS: The baseline ANP, BNP and cGMP plasma level was significantly higher in pts with CHD than in control group (ANP 144.4 vs 98.8 pg/ml p < 0.001; BNP 130.0 vs 97.2 pg/ml p < 0.001; cGMP 1.44 vs 0.86 pg/ml p < 0.001). In pts with CHF there was a significant increase ANP, BNP and cGMP plasma level 3 h after dig intravenous injection (ANP 205.2 vs 144.4 pg/ml p < 0.01; BNP 227.1 vs 130.0 pg/ml p < 0.01; cGMP 1.84 vs 1.44 pg/ml p < 0.01). The ANP and BNP plasma level after 3 days of oral dig was still significantly increased (ANP 171.1 vs 144.4 pg/ml p < 0.05; BNP 223.7 vs 130.0 pg/ml p < 0.01). ANP, BNP and cGMP plasma level was higher in pts with CHF also after 6 days of oral dig, but the difference was statistically significant. After 6 days of digoxin treatment there was a significant increase of ejection fraction (p < 0.005), with reduction of end-diastolic diameter of left ventricle (p < 0.05) and diameter of left atrium (p < 0.01). ANP at baseline correlated positively with baseline cGMP (r = 0.702 p < 0.05). On the 6th day BNP correlated positively with cGMP (r = 0.628 p < 0.05). 3 h after dig intravenous injection ANP correlated positively with BNP (r = 0.881 p < 0.05), but on the 3rd day of oral dig ANP correlated negatively with BNP (r = -0.536 p < 0.05). On the 6th day of oral dig end-diastolic diameter of left ventricle correlated negatively with BNP (r = -0.483 p < 0.05) and cGMP (r = -0.824 p < 0.05). CONCLUSIONS: 1. In pts with CHF a single intravenous digoxin injection increases ANP, BNP and cGMP plasma level. 2. Oral digoxin administration supports this beneficial neurohumoral effect and improves hemodynamic parameters of left ventricle as well as reduces left atrium diameter.

[Central nervous system dysfunction in patients with postresuscitation syndrome]. / Dynamika uszkodzenia osrodkowego ukladu nerwowego u chorych w okresie poresuscytacyjnym.

The work discusses the consequences of central nervous system dysfunction occurring in the course of postresuscitation syndrome (postresuscitation disease). Haemodynamic, morphological and metabolic changes in the central nervous system resulting from ischaemia and reperfusion in cerebral vessels have been discussed. Attention has been paid to the irreversibility and progressive character of certain changes in brain tissue initiated at the moment of cardiac arrest. The author also presents trials of management of the postresuscitation disease which have been undertaken so far and which concern pathophysiological mechanisms conditioning the development of brain injury as a result of cardiac arrest, resuscitation procedures and restoration of spontaneous circulation.

[Disturbances of the neurohumoral regulation in patients in critical illness and post-resuscitation period]. / Zaburzenia regulacji neurohumoralnej u chorych w stanach krytycznych i w okresie poresuscytacyjnym.

Cardiac arrest (CA) is an extreme stressful situation accompanied by impairment of hypotalamichypophyseal axis resulting from many reasons, specially when cardio-pulmonary resuscitation (CPR) has been delayed or prolonged. The author compares dysfunction of the neurohormonal system, including the release of hypophyseal and adrenal hormones, atrial natriuretic hormone and endothelin in patients in critical illness as well as in those after cardiac arrest. Associated consequences for the maintenance of homeostasis in postresuscitation period have also presented.

[Coronary artery disease in women]. / Choroba niedokrwienna serca u kobiet.

Data concerning coronary artery disease (CAD) refer to the recent clinical trials. They indicate that CAD is the most frequent cause of deaths of women over 50 years of age, and the dynamics of its development differs from that in male patients. The author discusses specificity of risk factors, effectiveness of various diagnostic methods, and different results of treatment of women with CAD (comparing to men).

[Alveolar-arterial oxygen gradient in patients with clinical symptoms of pulmonary embolism]. / Gradient pecherzykowo-tetniczy u chorych z klinicznymi objawami zatorowosci plucnej.

The accurate detection of pulmonary embolism is possible by means of non-invasive but very expensive ventilation-perfusion lung scanning or invasive and with high rate of complications pulmonary angiography. Thus monitoring of many clinical and biochemical parameters has been recently attempted to increase the probability of correct diagnosis of pulmonary embolism. The alveolar-arterial oxygen gradient is a more sensitive indicator of disturbance in oxygenation than occurrence of hypoxia in gasometry. The aim of our study was to examined the changes of the alveolar-arterial oxygen gradient in patients with pulmonary embolism. The survey was made in 35 patients aged from 41 to 75 with acute pulmonary embolism, of these 17 were men and 18 were women. We excluded patients with coexisting serious heart or lung disease. Pulmonary embolism was diagnosed on the grounds of presence of commonly known risk factors, sudden onset, findings on the chest radiography, hypoxia resistant to oxygen therapy, electrocardiography, echocardiography and catheterization of pulmonary artery using a Swan-Ganz catheter. The alveolar-arterial oxygen gradient was measured in arterial blood samples obtained 15 minutes after 100% oxygen ventilation, using standard formulae. All patients were administered heparin, oxygen and warfarine therapy. The control group consisted of 20 patients, 11 women and 9 men aged from 37 to 74, with deep venous thrombosis without coexisting heart or lung disease. In our study we showed that the alveolar-arterial oxygen gradient is a very useful parameter helping with diagnosis and monitoring efficacy of treatment in patients with pulmonary embolism without coexisting heart or lung diseases.

[Plasma concentrations of endothelin-1 and endothelin-2 in patients with pulmonary hypertension]. / Stezenie endoteliny-1,2 w surowicy chorych na nadcisnienie plucne.

Increased pressure in pulmonary artery is connected among other things with increased endothelin plasma concentration. The aim of the study was to assess plasma endothelin concentration in patients with pulmonary hypertension. The analysis comprised 22 patients with increased pressure in pulmonary artery in the course of pulmonary thromboembolism or chronic exacerbated left ventricular failure and 10 patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration was measured in pulmonary artery and capillary wedge pressure were evaluated with Swan-Ganz catheter and also peripheral and pulmonary vascular resistance were calculated. Endothelin plasma concentration in peripheral vein was compared between patients and healthy volunteers. Plasma endothelin concentration in pulmonary artery, peripheral artery and vein was higher in patients with pulmonary hypertension than in patients with chronic exacerbated left ventricular failure without pulmonary hypertension. Plasma endothelin concentration in patients with chronic exacerbated left ventricular failure without pulmonary hypertension was higher in pulmonary artery than in peripheral artery and vein. At these patients plasma endothelin concentration in the peripheral vein didn't differ significantly from the healthy volunteers.

[The effect of intravenous magnesium on the arrhythmias in patients after electrical cardioversion]. / Wplyw dozylnie podawanego roztworu magnezu na zaburzenia rytmu serca u chorych po kardiowersji elektrycznej.

The aim of this study was to examine the effect of magnesium, applied by intravenous infusion, on supraventricular and ventricular cardiac arrhythmias in patients after effective electric cardioversion. 30 patients examined were: 4 women and 26 men aged from 24 to 84 years (the average age being 56.1). All patients had previously been treated successfully by electric cardioversion. Patients were divided into two groups: group 1 of 15 patients aged 24 through 74 years, group 2 of 15 patients aged 25 through 76 years. After effective cardioversion, in the first group of patients, the infusion of 500 ml 0.9% NaCl was applied; whereas the other group of patients received 500 ml 0.9% NaCl with 5g MgSO4 and 20 mEq KCl. After electric cardioversion all patients had 24-hour Holter monitoring. After successful electric cardioversion in all the examined patients, supraventricular and ventricular cardiac arrhythmias were observed. However, in group 2 numerous premature supraventricular beats, episodes of atrial fibrillation, numerous premature ventricular beats, multifocal premature ventricular beats and pairs of ventricular beats were rarer than in the 1st group. In conclusion, it should be stated that the intravenous application of magnesium can be an effective method of treating supraventricular et ventricular cardiac arrhythmias occurring with patients after electric cardioversion.

[The study of the activity of creatine kinase in diagnosis of coronary reperfusion in patients with acute myocardial infarction after thrombolysis]. / Badania aktywnosci kinazy kreatynowej dla oceny przywrócenia krazenia wiencowego u chorych na zawal miesnia serca leczonych trombolitycznie.

Early estimation of the efficacy of thrombolysis in acute myocardial infarction is of great clinical importance because the appearance of coronary reperfusion changes therapeutic and diagnostic procedures and decreases the mortality rate. Previous studies showed that the analysis of activity of creatinine kinase (CPK) measured in regular, short periods of time after thrombolysis night be useful in the diagnosis of reperfusion equally to coronary angiography. The aim of the study was to estimate the usefulness of the analysis of creatine kinase (CPK) and its isoenzyme (CK-MB) in the diagnosis of coronary reperfusion in patients with acute myocardial infarction after thrombolytic therapy. The study was performed in 50 patients with acute myocardial infarction admitted to our Cardiology Department, of these 42 were men aged from 34 to 68 and 8 were women aged from 43 to 70. 28 patients had acute inferior myocardial infarction, 22 patients--acute anterior myocardial infarction. All patients were administered 300 mg of aspirin after admission and then 150 mg of aspirin daily and 1,500,000 IU of streptokinase i.v. within 1 hour. Venous blood samples for determination of CPK and CK-MB were obtained every 3 hours during the first 48 h and once a day at 8 a.m from 3rd to 11th day. All patients underwent coronary angiography 2-4 weeks after thrombolysis. The study showed that in patients with reperfusion, activities of CPK and CK-MB three hours after thrombolysis were higher than 30% of later peak. These findings show the usefulness of this criterion in early, non-invasive estimation of efficacy of thrombolysis. Determination of activity of isoenzyme CK-MB during thrombolytic therapy is not necessary, because it evaluates similarly to CPK. We showed that electrocardiographic and enzymatic criteria are comparable in estimation of efficacy of thrombolytic therapy.

[Magnesium: its significance in cardiology]. / Magnez--znaczenie w kardiologii.

The significance of magnesium in the etiology and treatment of diseases of the circulatory system has been investigated for several decades. Experimental, clinical and epidemiological data concerning this problem are abundant, however their findings do not let--at least so far--to draw unequivocal conclusions as to the significance of this element in the treatment of cardiovascular diseases. Mg++ is known to be responsible for the function of about 300 enzymes, and its deficiency results in necrosis of the cells due to depletion of energetic stores of phosphates, leads to disturbances in fat metabolism, increased aggregation and shortened survival time of platelets, increased level of factor III, disturbed synthesis of proteins (mitral valve leaflet prolapse) as well as of prostanoid function. Despite the fact that serum level of Mg++ differs from its concentration in tissues, majority of clinical studies relies on serum levels of the element. The effects of changes in serum levels of Mg++ resulting from various pathophysiological processes should be differentiated from the effects of magnesium supplementation or from administration of the element in excess for therapeutic reasons when the levels in the organism have been considered normal.

[Sodium efflux through lymphocytic cell membranes in patients with chronic respiratory insufficiency]. / Przeplyw sodu przez blony komórkowe limfocytów u chorych z przewlekla niewydolnoscia oddechowa.

Disturbances of Na(+)-K(+)-ATPase activity in patients with respiratory insufficiency may cause the hypertonia of non-striated muscles, which leads to increased peripheral resistance or bronchoconstriction, and also may inhibit the uptake of catecholamines and therefore may intensify their action on the respiratory and circulatory systems. All this is very harmful in respiratory insufficiency. The aim of the study was the examination if there are any changes in sodium efflux through lymphocytic cell membrane in patients with chronic respiratory insufficiency and if retraction of insufficiency can influence the activity of Na(+)-K(+)-ATPase. The study was performed in 40 patients with chronic respiratory insufficiency, of these 11 were women aged from 58 to 72 years and 29 were men aged from 62 to 77 years. Control group consisted of 31 healthy persons, of these 9 were women aged from 37 to 55 and 22 years were men aged from 21 to 60 years. In the study we included patients with exacerbation of chronic obstructive pulmonary disease (COPD). Blood samples were obtained during the exacerbation of COPD and after partial improvement. We determined arterial blood gases and rates of total, ouabain-sensitive and furosemide-sensitive sodium efflux through lymphocytic cell membrane in venous blood. The rates of sodium efflux were estimated with the method described by Haegerty et al. In the study we showed that in patients with exacerbation of COPD rates of total and ouabain-sensitive sodium efflux through lymphocytic cell membrane were decreased, but after improvement of the disease these rates normalized. In patients with exacerbation of COPD rates of furosemide-sensitive sodium efflux were normal. Disturbances of activity of Na(+)-K(+)-ATPase in patients with exacerbation of chronic pulmonary insufficiency are due to hypoxia.

[Sodium efflux through lymphocytic cell membranes in patients with acute myocardial infarction]. / Przeplyw sodu przez blony komórkowe limfocytów u chorych na swiezy zawal miesnia serca.

One of the reasons of ventricular arrhythmias and coronary artery spasms in patients with acute myocardial infarction (AMI) may be the lower Na(+)-K(+)-ATPase activity, which causes decrease of potassium intracellular concentration and increase of calcium intracellular concentration. The aim of the study was the examination of the rate of sodium efflux through the lymphocytic cell membrane in patients with AMI after thrombolytic therapy. The survey was made in 50 patients with AMI after thrombolytic therapy: 30 of them with reperfusion (group I) and 20 without reperfusion (group II). The control group consisted of 31 healthy persons. Rates of total, ouabain-sensitive and furosemide-sensitive sodium efflux through the lymphocytic cell membrane were measured before thrombolysis, then 3 and 5 days after, using the method elaborated by Haegerty et al. All patients were treated with aspirin, glyceryl trinitrate and thrombolysis therapy with alteplase (r-TPA). In all patients with AMI rates of total and ouabaine-sensitive sodium efflux through the lymphocytic cell membrane were decreased, but rates of furosemide-sensitive sodium efflux were normal. In patients after thrombolytic therapy with reperfusion, 3 and 5 days after thrombolysis the decreased rates were normal, but they were still decreased in patients without reperfusion.

[The influence of electrical cardioversion on left ventricular systolic function, left atrial size, ANP levels and enzymatic activity of CPK and CD-MB in serum of patients with paroxysmal atrial fibrillation]. / Wplyw kardiowersji elektrycznej na czynnosc lewej komory serca, wielkosc lewego przedsionka oraz stezenie ANP i aktywnosc enzymatyczna CPK i CK-MB w surowicy u chorych na napadowe migotanie przedsionków.

OBJECTIVE: To estimate the influence of electrical cardioversion on the left ventricular systolic function, left atrial size, the plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) and plasma level of atrial natriuretic peptide (ANP) in patients with paroxysmal atrial fibrillation caused by coronary artery disease, hypertension or mitral valve disease. PATIENTS: The study underwent 36 patients with paroxysmal atrial fibrillation of mean duration 24.5 hours in which sinus rhythm was restored by electrical cardioversion. METHODS: Plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB), plasma level of atrial natriuretic peptide (ANP) and echocardiographic examination were obtained before and 24 hour after electrical cardioversion. During echocardiographic examination were measured left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left atrial size (LA) and early diastolic velocity(E) and velocity with atrial contraction (A) of left ventricular inflow. Electrical cardioversion was initiated with impulse of 100 J. If it failed to convert atrial fibrillation to sinus rhythm next impulse of 200 J and 360 J were consequently applied. RESULTS: In all subgroups of patients formed dependently on a number of electrical shocks, 24 hour after cardioversion significant increase in left ventricular ejection fraction (LVEF) and decrease in plasma level of ANP were noted. In subgroup of patients treated with 1 (100 J) and 2 (100 + 200 J) impulse significant decrease in left atrial size was found out. The increase in plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) was confined to the subgroup treated with 3 (100 + 200 + 360 J) impulses. No changes in left ventricular end diastolic diameter (LVEDD) and early velocity (E) of left ventricular inflow 24 hours after cardioversion were observed. In all patients electrical cardioversion brought about the appearance of atrial wave of left ventricular inflow. No differences in estimated parameters between patients with coronary artery disease, hypertension and mitral valve disease were observed. Significant positive correlation between plasma level of ANP and left atrial size before (r = 0.69, p < 0.001) and after cardioversion (r = 0.68, p < 0.0001) were found. CONCLUSIONS: Restoration of the sinus rhythm in patients with paroxysmal atrial fibrillation leads to the increase in left ventricular ejection fraction (LVEF) and to the decrease in left atrial size (LA) and the plasma level of atrial natriuretic peptide. Left atrial size and plasma level of ANP are related. The cardioversion with impulses of high energy increases the plasma activity of creatinine phosphokinase and its myocardial fraction.

[Myoglobin concentration in serum as an early marker of reperfusion in patients with acute myocardial infarction after thrombolytic therapy]. / Stezenie mioglobiny w surowicy jako wczesny wskaznik udroznienia tetnic wiencowych u chorych ze swiezym zawalem serca leczonych trombolitycznie.

Detection of coronary artery reperfusion in patients after thrombolytic therapy because of acute myocardial infarction includes, except angiography, disappearance of anginal pain, regression of electrocardiographic and echocardiographic myocardial ischaemia symptoms, increased activity of creatine kinase (CPK) and its isoenzyme CK-MB. The aim of the study was to check whether changes in myoglobin serum concentration could be an early marker of coronary artery reperfusion after thrombolysis in patients with acute myocardial infarction. The studies comprised 50 patients treated by thrombolysis due to threatening myocardial infarction, including 29 men and 21 women aged 43-84 years. The patients were divided into 2 groups: the first (i)-patients without symptoms of coronary artery reperfusion and the second (ii)-those with symptoms of coronary artery reperfusion. It was assumed that the basis for successful reperfusion would be the reduction of total elevations of the ST segment 70% or more in electrocardiographic recording performed 3 hours after the start of thrombolytic treatment. Reperfusion was considered completely unsuccessful when reduction of total elevations was less than 30%. In patients with reperfusion after thrombolysis the concentrations of myoglobin were much higher and the activity of CPK and CK-MB significantly more intensive in comparison with patients without reperfusion symptoms in electrocardiographic assay. The evaluation of myoglobin concentration, CPK and CK-MB activity in the 3rd hour after the start of thrombolytic treatment in relation to maximum values is characterised by high sensitivity and specificity in the prediction of reperfusion onset Maximum myoglobin concentration in serum appears significantly earlier than maximum CPK and CK-MB activity and this marker is characterised by higher sensitivity and specificity in the evaluation of coronary artery reperfusion than the activity of CPK and CK-MB.