RETROSPECTIVE STUDY OF EVALUATION OF PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION AND INTACT CORONARY ARTERIES. EVALUATION OF TREATMENT APPROACHES; OUTCOME AND PROGNOSIS.

Myocardial infarction with normal coronary arteries is a well known pathology. It may or may not be associated with left ventricle wall motion abnormalities. Data was reviewed retrospectively for patients with ST elevation myocardial infarction who underwent cardiac catheterization. From the total number of patients evaluated 10.3% (17) patients had Myocardial Infarction with normal coronary arteries. Females were more likely to present with MINCA then males. Coronary flow was normal in 11 from 17 patients with MINCA. In 6 cases slow coronary flow was detected. Myocardial segments with slow coronary flow did not correlate with wall motion abnormalities detected by echocardiography and ventriculography. In 8 females, Takotsubo cardiomyopathy was suspected. Data were analyzed retrospectively and we were not able to obtain full coagulation panel for all evaluated patients. Myocardial biopsy was not performed in either of patients under observation. Spontaneous thrombolysis was suspected in number of cases. Most angiography investigations were done within three hours after symptoms start. Prognosis of patients with ST-elevation Myocardial Infarction (STEMI) and normal coronary arteries was good. No fatal or non-fatal complications during hospitalization. During 6 month, follow up one male patient was re-hospitalized due to Acute Coronary Syndrome (ACS) in 5.5 month after initial event. Repeated coronary angiography did not reveal the abnormalities. Our study is first attempt for collecting retrospectively different data for patients with STEMI and NCA. Important is that no correlation was found between wall motion abnormalities and coronary flow limitations (if present). Compared to other studies we found higher incidences of wall motion abnormalities detected by echocardiography and/or ventriculography. Future prospective design studies in STEMI and NCA are warranted to understand the pathophysiology and define right treatment approaches. Stress may be considered as prominent factor, but future studies are needed with psychological evaluation; autonomous nerves system testing and catecholamine levels determination to verify its role in this pathology.

THE SAFETY AND EFFICACY OF AMIODARONE AND CARVEDILOL COMBINATION IN TREATMENT OF PATIENTS WITH SEVERE CARDIAC RHYTHM DISORDERS.

Different arrhythmias are cause of sudden death in many patients with heart failure. Amiodarone is usually used for prevent this arrhythmias, but it is not drug of choice for treatment the patients with heart failure. We retrospectively analyzed 142 patients with moderate and severe heart failure and history of myocardial infarction. These patients have received amiodarone, carvedilol or combination of these two medications together with standard therapy. In our retrospective analysis, the combination therapy with Amiodarone and Carvedilol had highly significant decrease arrhythmic death compare with carvedilol and amiodarone groups. This therapy is more effective in recovering of sinus rhythm in patients with atrial fibrillation and for control ventricular arrhythmias. The effects of carvedilol on left ventricular remodeling, systolic function and symptomatic status are not affected adversly by concurrent treatment with amiodarone. Carvedilol is an effective additional therapy for the patients with chronic heart failure already receiving Amiodarone. Carvedilol can be added to Amiodarone in patients with severe ventricular rhythm disorders and increased risk of sudden death without expecting of increase adverse events (than either drug alone) or loss of clinical efficacy.

QTC TENDENCY IN PACEMAKER DEPENDENT PATIENTS - PROGNOSTIC MEANING OF LONG QTC DURING 5 YEAR FOLLOW UP.

Prolongation of ventricular repolarization, which is represented by QTc prolongation on the standard ECG can be considered as increased risk for fatal arrhythmia. However, in pacemaker dependency (with ventricular pacing from the right apex) Ventricular Pacemaker causes abnormal steps of ventricular activation and therefore widens QRS complex and alters ventricular repolarization. It is still questionable whether QTc prolongation in right ventricular-paced patients is associated with increased risk of fatal arrhythmia or other cardiac complications. The other important question is whether the pacemaker dependent patient with long QTc interval may safely receive medications with known potential to prolong ventricular repolarization. The aim of the study was to determine whether QTc prolongation in VP (ventricular pacemaker) patients is associated with increased risk of fatal arrhythmia or other cardiac complications and whether these patients can safely receive medications with known potential to prolong ventricular repolarization. The study is based on retrospective analysis of the QTc interval prior and after pacemaker insertion; dynamic changes of QTc interval and possible influence of the medications, with known potential to prolong ventricular repolarization. Study population consisted 76 patients with narrow native QRS complexes and QTcF/QTcB <500 ms for both male and female patients. QTc prolongation in VP patients most likely does not represent true repolarization abnormalities and is not associated with risk of fatal arrhythmia. While analysis of group receiving medications with known potency of QTc increase we found no additional tendency of QTc increase. Based on our data receiving the medications with known potency of QTc prolongation in VP patients should be considered as safe approach. Long-term follow up data (5 years) assessed retrospectively shows that in patients with widened QRS after VP are at increased risk of development of HF and HF decompensation.

Studies of troponin I level changes in patients with coronary artery disease after percutaneous coronary intervention.

Research has been carried out in TSMU Cardiology department of A.Aladashvili University Clinic involving 150 patients with ischemic heart disease. The changes of Tn level before and after percutaneous coronary intervention (PCI) in patients with CAD as well as its dependence on the cardiovascular events rate have been studied in previous work. In patients with normal Tn I level before and after PCI hospital cardiovascular events rate occurred to be as low as the rate of later events. Elevated level of Tn I after PCI was associated with increased rate of complications, which were mostly appeared in those patients with high level of Tn I before PCI. High level of 30-day mortality was revealed in patients with normal level of Tn I before PCI, which was elevated after procedure. The highest rate of later mortality was demonstrated in patients with high level of Tn I before PCI that was sustained after procedure. Hence, on the basis of our data we can conclude, that the Tn level before and after PCI has a prognostic significance; High level of Tn I before PCI is associated with increased hospitalization and later mortality rates. The elevation of Tn I after PCI in patients with normal initial level is more significant predictor of early (30-day) mortality compared to later (within 12 months) mortality.