The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6-174G > C gene polymorphism.

BACKGROUND: The interleukin-6 (IL-6) promoter -174G/C polymorphism (rs1800795) is associated with enhanced systemic inflammatory response to injury. However, data on the effect of this polymorphism on inflammatory markers in patients undergoing coronary artery bypass grafting surgery (CABG) are inconsistent. The aim of our study was to investigate whether -174G/C IL-6 polymorphism affects plasma IL-6 and C-reactive protein (CRP) concentrations in patients undergoing CABG. METHODS: A total of 179 consecutive white patients (77% men, aged 65 +/- 8.6 standard deviation [SD] y) scheduled for elective isolated CABG were studied. Pre- and postoperative CRP and IL-6 levels were analysed in relation to the 174G/C IL-6 polymorphism determined by using TaqMan single-nucleotide polymorphism genotyping technique. RESULTS: The genotype distribution was as follows: GG -46 (26%), GC -93 (52%) and CC -40 (22%). The C allele carriers had higher baseline CRP (4.1 +/- 0.35 versus 2.4 +/- 0.59 mg/L, P = 0.02) and IL-6 levels (3.0 +/- 0.17 versus 2.2 +/- 0.3 pg/mL, P = 0.02) than GG patients. Five to seven days after CABG, CRP levels rose by 54% (P = 0.03), and IL-6 levels tended to be higher (P = 0.07) in -174C allele carriers than the non-carriers. There were no associations between -174G/C IL-6 polymorphism and any demographic-, clinical- or procedure-related variables as well as major adverse cardiovascular events. Multivariate regression analysis, including sex, age, body mass index, hypercholesterolaemia, smoking, hypertension diabetes, identified CG + CC genotype as the only independent predictor of preoperative CRP and IL-6 levels. CONCLUSIONS: The presence of the -174C allele determines to some extent higher plasma CRP and IL-6 concentrations pre- and postoperatively in CABG patients.

[Selected aspects of diagnosis and management of cardiac arrhythmias. Some aspects of arrhythmogenic mechanisms]. / Wybrane zagadnienia z diagnostyki i leczenia zaburzen rytmu serca. Wybrane zagadnienia z patogenezy zaburzen rytmu serca.

The mechanisms responsible for the development of cardiac arrhythmias have been discussed, including altered automaticity, triggered activity and reentry. The role of the substrate, triggering factor and factors modifying the development of the reentry has also been analysed. The contribution of electromechanical interactions to the occurrence of cardiac arrhythmias has been found noteworthy.

[Relationship between pain and panic in mitral valve prolapse syndrome]. / Zaleznosc miedzy bólem a lekiem w zespole wypadania platka zastawki mitralnej.

The study aimed at assessing a relationship between pain and panic in the echocardiographically confirmed mitral valve prolapse syndrome. Thirty three patients, 23 women and 10 men, were included. Mean age was 32 years. Standard Pain Perception Questionnaire by Melzack and Ostrowski's Well Being Questionnaire were used. During examination all patients were free from pain. Therefore, delayed pain effect was assessed. Present pain was evaluated with different scale. Significant relationship between pain and panic was shown in the mitral valve prolapse syndrome. In retrospective analysis pain was responsible for 16% of panic disorders (n = 0.396; p < .02). An effect of the actual pain is less pronounced and explain 14% of panic disorders (n = 0.372; p < .02), as the actual pain was less intense. There was also contrary relationship, but weaker. Panic exerts an effect on pain intensity in 11% (n = 0.330; p < .05). In the system pain-panic the former is prevailing in this syndrome. The obtained results confirm the value of psychotherapy modifying panic disorders.

Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse.

The aim of this study was to evaluate a possible relation between the autonomic tone determined by daily urine catecholamine excretion and the incidence of ventricular arrhythmias (VA) in patients with mitral valve prolapse (MVP). The study included 53 patients (31 women and 22 men) aged 19-52 years (mean age 32.7). The diagnosis of MVP was based on medical history, physical examination, and echocardiography. Cardiac arrhythmias were detected by Holter monitoring and classified according to Lown grades. Daily heart rate and duration of corrected QT interval using Basett's formula were also analyzed. Daily urine adrenaline and noradrenaline levels were determined fluorometrically by Von Euler and Lishajko's method. The patients with Lown's grade III-V VA were evaluated with particular consideration. Student's t-test was used for statistical analysis. On Holter monitoring 26 patients showed VA, including 6 with grade I, 11 with grade II, 2 with grade III, 4 with grade IV, and 3 with grade V according to Lown's classification. The remaining 27 patients were free of cardiac arrhythmias. Mean daily heart rate ranged from 54-93 beats/min (73 +/- 8.44, mean +/- SD) and corrected QT from 336-494 ms (411 +/- 37.17). Daily adrenaline and noradrenaline excretion for the whole group of patients were 0.01-16.2 micrograms (2.1 +/- 2.38) and 1.6-31.0 micrograms (13.1 +/- 7.27), respectively, which was within normal range. However, the patients with serious ventricular arrhythmias showed significantly higher daily adrenaline excretion. Individual analysis of two-thirds of patients with ventricular arrhythmias grade III-V showed daily urine noradrenaline levels exceeding mean values for the whole group.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of enalapril on cardiac arrhythmias in patients with congestive heart failure.

The purpose of the study was to evaluate the effect of enalapril on the frequency of ventricular premature beats in patients with congestive heart failure. The study group consisted of 30 patients with a mean age of 47 +/- 0.6 years with chronic congestive heart failure (NYHA classes III and IV) due to primary dilated cardiomyopathy and cardiomyopathy in the course of ischaemic heart disease. Initial therapy with digitalis and diuretics was supplemented with enalapril at a dose of 5-20 mg daily. Initially and at three months after enalapril, the following parameters were evaluated: NYHA functional class, the presence of premature ventricular beats in 24-hour ECG recording and left ventricular function by echocardiography. The scheduled therapy was completed by 23 patients; in 5 patients, the intake was discontinued because of hypotension, one patient died after 14 days due to worsening heart failure, and one patient was submitted for pacemaker implantation. Clinical improvement manifesting itself by a shift to lower NYHA classes was found in 20 patients. A reduced number of premature ventricular beats was observed in 52% of the patients. Termination of cardiac arrhythmias, especially of complex beats, was parallel to the circulatory improvement.

[Signal-averaged ECG and left-ventricular function in patients with severe ventricular arrhythmia in ischemic heart disease]. / EKG metoda usredniania sygnalu a czynosc lewej komory u chorych z groznymi komorowymi zaburzeniami rytmu w przebiegu choroby niedokrwiennej.

In 35 patients with ischemic heart disease we evaluated the incidence of ventricular late potentials and left ventricular function. The patients were divided into two groups: group A consisting of 15 patients (14 men, 1 woman) aged from 40 to 71 years (mean age 56) with previously documented ventricular tachycardia or fibrillation, and into group B comprising 20 subject (16 men, 4 women) aged from 35 to 62 years (mean age 50) with ischemic heart disease without the above-mentioned arrhythmias. Time from the development of ventricular tachycardia or fibrillation was 3 weeks to 4 years. The incidence of arterial hypertension and previous myocardial infarction was similar in both groups. Body surface late potentials were recorded by signal averaging technique according to Simson using Frank's orthogonal XYZ lead system. In addition, in all the patients 24-hour ECG monitoring was performed to reveal any ventricular rhythm disturbances and echocardiography was used to evaluate left ventricular function. The presence of the ventricular late potentials meeting at least two of the Simson's--Dene's criteria was found in 13 (87%) patients in group A and in 2 (10%) patients from group B. In the patients after ventricular tachycardia or fibrillation the mean values of th total QRS duration (QRS-D) and the low amplitude signal duration (LAS40) were higher whereas the root mean square voltage of the last 40 ms of th vector magnitude QRS (RMS) was lower (154 ms, 56 ms, 15 muV, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Complex ventricular arrhythmias in ischemic heart disease]. / Zlozone arytmie komorowe w chorobie niedokrwiennej serca.

The purpose of the study was to describe the clinical picture in patients with ischemic heart disease (IHD) and verifying severity of ventricular arrhythmias. The study included 856 patients with IHD aged 23-88 years (mean = 55.3), including 659 men and 197 women. Holter monitoring was performed in all patients. Ventricular arrhythmias were graded according to Lown. The patients were divided into five groups: group 1-349 patients with Lown's grade 1 and 2; group 2-95 patients with grade 3; group 3-152 patients with grade 4a and 4b; group 4-11 patients with grade 5; group 5-507 patients (selected from groups 2, 3 and 4) with Lown's grade 3 and 4 or 5. Arterial hypertension was found in 17.1%, myocardial infraction in 66%, and syncope in 12.3% of the patients. The patients with complex ventricular arrhythmias versus Lown's grade 1 and 2 show significant differences especially in respect to: the frequency of previous anterior myocardial infraction, the incidence of pain at rest, loss consciousness, the frequency of ventricular tachycardia and fibrillation, anginal pain and exercise-related arrhythmias. The patients with Lown's ventricular arrhythmia grade 3-5 do not differ significantly in their clinical manifestations of IHD from the patients with ventricular arrhythmias grade from 3 to 5. The development of silent myocardial ischemia during exercise stress testing is typical also for the patients with complex ventricular arrhythmias. A decreased contractility index, ejection fraction and dyskinesis are significantly more frequent in the patients with complex ventricular arrhythmias.

[Arrhythmia in patients with mitral valve prolapse syndrome and the status of the sympathetic nervous system]. / Zaburzenia rytmu serca u chorych z zespolem wypadania platka zastawki mitralnej a stan napiecia ukladu wspólczulnego.

The study aimed at evaluating a possible relationship between the adrenergic system tone determined with the excretion of catecholamines with the urine and an incidence of the ventricular arrhythmias in patients with the mitral valve prolapse. The study included 20 patients (13 women and 7 men aged between 20 and 50 years; mean = 31.6 years) with the mitral valve prolapse syndrome diagnosed with the aid of the patients' history, physical examinations and echocardiography. Echocardiograms have shown anterior mitral leaflet prolapse in 7 patients, posterior mitral leaflet prolapse in 8 patients, and both mitral leaflets prolapse in the remaining 5 patients. Daily excretion of adrenaline and noradrenaline was measured with Van Euler and Lishajko's fluorimetric technique. Cardiac arrhythmias were determined with a 24-hour ECG monitoring and classified according to Lown. Premature ventricular contractions of class I were seen in 1 patient, of class II in 5, class III in 1, class IV in 2, and class V in 3 patients. Holter monitoring technique did not show the arrhythmias in 8 patients. Daily adrenaline and noradrenaline excretion with the urine was within the normal values (3.2-30.8 ug and 0.2-16.2 ug, respectively) in all examined patients. Daily urine noradrenaline was higher in patients with serious ventricular arrhythmias (Lown's class V) than mean values in the whole examined group.

[The effects of lorcainide on the ECG pattern and left ventricular function in a patient with recurrent ventricular tachycardia]. / Wplyw Lorcainidu na orbaz ekg oraz funkcje lewej komory u chorego z nawracajacymi czestoskurczami komorowymi.

The paper presents an adverse effect of Lorcainide on the electrocardiographic pattern and left ventricular function in a patient with recurrent ventricular tachycardia in the course of arterial hypertension and ischemic heart disease. Based upon this case report a relatively new and not well known phenomenon of drug arrhythmogenesis is presented.

Clinical value of cordarone as an antiarrhythmic agent.

The antiarrhythmic efficacy of Cordarone was studied in 90 patients (64 men and 26 women) aged 16-76. Cordarone appeared to be efficacious in the treatment of resistant arrhythmias, particularly ventricular extrasystoles and paroxysmal tachycardia in the WPW syndrome. Total disappearance of dysrhythmias was achieved in 40%, and good therapeutic effects in 32% of patients (an overall 72 percent success). Rapid initial loading (800-1200 mg/day) and continuation with a maintenance dose (100-400 mg/day) may be used as an optimal therapy model. Cordarone is well tolerated even with prolonged use. Side-effects necessitated drug withdrawal in 4.4% of patients. It is possible to combine Cordarone with other selected antiarrhythmic drugs in most resistant rhythm disturbances.