What Else Can AI See in a Digital ECG?

The electrocardiogram (ECG), considered by some diagnosticians of cardiovascular diseases to be a slightly anachronistic tool, has acquired a completely new face and importance thanks to its three modern features: the digital form of recording, its very frequent use, and the possibility of processing thousands of records by artificial intelligence (AI). In this review of the literature on this subject from the first 3 months of 2023, the use of many types of software for extracting new information from the ECG is described. These include, among others, natural language processing, backpropagation neural network and convolutional neural network. AI tools of this type allow physicians to achieve high accuracy not only in ECG-based predictions of the patient's age or sex but also of the abnormal structure of heart valves, abnormal electrical activity of the atria, distorted immune response after transplantation, good response to resynchronization therapy and an increased risk of sudden cardiac death. The attractiveness of the presented results lies in the simplicity of the examination by the staff, relatively low costs and even the possibility of performing the examination remotely. The twelve studies presented here are just a fraction of the novelties that the current year will bring.

A systematic review of nonsynonymous single nucleotide polymorphisms in the renin-angiotensin-aldosterone system

In this recent publication review the authors aimed to collect evidence of impact of nonsynonymous single nucleotide polymorphisms (nsSNP) in the renin-angiotensin-aldosterone system on patients' phenotype not only regarding arterial hypertension and its complications, but also the impact on other diseases of interest outside the field of cardiovascular medicine. PubMed database records published between 2017-2020 were searched and all positive case-control studies or positive studies with human DNA were selected. The search identified 104 articles, of which 22 were included on the basis of the inclusion criteria. This paper presents the impact of 44 nsSNPs in panels for genes of renin, angiotensinogen, angiotensin-converting enzyme, angiotensin receptor and aldosterone on the clinical picture of investigated cohorts or on the peptide-protein interactions as consequence of nsSNPs. Genetic variability in nsSNPs of the RAAS is involved in the pathogenesis of arterial hypertension and its complications, and surprisingly also in the pathogenesis of conditions not associated with elevated blood pressure, like neoplasms or inflammatory diseases.

Flow-mediated skin fluorescence: A novel method for the estimation of sleep apnea risk in healthy persons and cardiac patients

BACKGROUND

A pilot study revealed a relationship between the results of flow mediated skin fluorescence (FMSF) and of ECG-Holter-based estimated apnea/hypopnea index (eAHI) in asymptomatic individuals. The aim of this study was to test whether the results of FMSF show a relationship with the eAHI in patients with coronary artery disease or aortic stenosis.

METHODS

Twenty-one patients (12 coronary disease, 9 aortic stenosis) and 37 healthy volunteers were included. FMSF was assessed before, during and after the pressure occlusion of the brachial artery, using a prototype device allowing the quantification of skin fluorescence. The values of FMSF expressed as baseline (BASE), maximum (MAX), and minimum (MIN) were analyzed. The percentages of ischemic response (IR) and hyperemic response (HR) were calculated. The eAHI was assessed from night ECG-Holter recordings. Differences between the groups and the relationships between the parameters were analyzed statistically.

RESULTS

Mean ± standard deviation of BASE, MAX, MIN and IR were not significantly different in both groups (p > 0.05). HR was significantly lower in cardiac patients (14.7 ± 7.5 vs. 11.8 ± 5.1; p = 0.048), whose eAHI was significantly higher (11.0 ± 7.4 vs. 36.3 ± 16.5; p < 0.01). Negative correlation for MAX and eAHI was found in volunteers and patients: r = -0.38, p = 0.02 and r = -0.47, p = 0.03, respectively. In volunteers, HR had a negative correlation with eAHI: r = -0.34, p = 0.04.

CONCLUSIONS

This pioneer study confirms that FMSF can be used to detect the negative correlation between MAX fluorescence and eAHI not only among healthy volunteers, but also among cardiac patients with coronary artery disease or aortic stenosis.

Searching for serum biomarkers linking coronary heart disease and Helicobacter pylori infection using infrared spectroscopy and artificial neural networks

Helicobacter pylori (Hp) Gram-negative bacteria cause gastritis or gastric ulcers. They may be involved in the development of systemic diseases i.e. coronary heart disease (CHD). Both Hp infection and CHD are related to inflammation accompanied by C-reactive protein (CRP), tumor necrosis factor alfa (TNF-α) and homocysteine. Low density lipoprotein (LDL) and triglicerides are a classic risk factors of CHD. Infrared spectroscopy has been introduced for monitoring chronic infections or endogenous disorders using specific absorption bands for biocomponents typed as diagnostic markers. In this study we selected specific motives of infrared radiation (IR) spectra for the sera from CHD patients infected with Hp. In total 141 sera were used: 90 from patients with CHD, all Hp positive, and 51 from healthy donors, 32 Hp negative and 21 Hp positive. Hp status was evaluated by anti-Hp IgG antibodies and/or ¹³C urea breath testing. IR spectra were measured using FT-IR/FT-NIR Spectrum 400 spectrometer (PerkinElmer) chemometrically analyzed using artificial neural networks and they showed differences in absorption bands corresponding to triglicerides, CRP, homocysteine, LDL and TNF-α, and selected component groups between CHD patients infected with Hp vs healthy uninfected donors (96.15% accuracy). Triglicerides and CRP were the best biomarkers linking Hp infection with CHD.

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid

The Gastric pathogen Helicobacter pylori (HP) may influence the development of coronary heart disease (CHD). H. pylori induce reactive oxygen species (ROS), which transform cholesterol to 7-ketocholesterol (7-kCh), a CHD risk factor. Acetylsalicylic acid (ASA)—an Anti-aggregation drug used in CHD patients—may increase gastric bleeding and inflammation. We examined whether H. pylori driven ROS effects in the cell cultures of gastric epithelial cells (AGS) and vascular endothelial cells (HUVEC) progress in the milieu of 7-kCh and ASA. Cell cultures, exposed to 7-kCh or ASA alone or pulsed with the H. pylori antigenic complex—Glycine acid extract (GE), urease (UreA), cytotoxin associated gene A (CagA) protein or lipopolysaccharide (LPS), alone or with 7-kCh and ASA—were examined for ROS, apoptosis, cell integrity, interleukin (IL)-8, the activation of signal transducer, the activator of transcription 3 (STAT3), and wound healing. ASA and 7-kCh alone, and particularly in conjunction with H. pylori components, increased the ROS level and the rate of apoptosis, which was followed by cell disintegration, the activation of STAT3, and IL-8 elevation. AGS cells were unable to undergo wound healing. The cell ROS response to H. pylori components may be elevated by 7-kCh and ASA.

Ankyrins in human health and disease - an update of recent experimental findings

Ankyrins are adaptor molecules that in eukaryotic cells form complexes with ion channel proteins, cell adhesion and signalling molecules and components of the cytoskeleton. They play a pivotal role as scaffolding proteins, in the structural anchoring to the muscle membrane, in muscle development, neurogenesis and synapse formation. Dysfunction of ankyrins is implicated in numerous diseases such as hereditary spherocytosis, neurodegeneration of Purkinje cells, cardiac arrhythmia, Brugada syndrome, bipolar disorders and schizophrenia, congenital myopathies and congenital heart disease as well as cancers. Detecting either down- or over-expression of ankyrins and ergo their use as biomarkers can provide a new paradigm in the diagnosis of these diseases. This paper provides an outline of knowledge about the structure of ankyrins, and by making use of recent experimental research studies critically discusses their role in several health disorders. Moreover, therapeutic options utilizing engineered ankyrins, designed ankyrin repeat proteins (DARPins), are discussed.

Quantitative assessment of the rotation and twist of the left ventricle during dobutamine stress echocardiography: a comparison of patients with and without significant coronary artery disease

BACKGROUND

The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE).

AIMS

We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD).

METHODS

We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2‑dimensional speckle‑tracking echocardiography, and twist was calculated as the difference between the basal and apical rotation.

RESULTS

Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge.

CONCLUSIONS

During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.

Autoantibodies to a specific peptide epitope of human Hsp60 (ATVLA) with homology to Helicobacter pylori HspB in H. pylori-infected patients

Helicobacter pylori (Hp) may initiate autoimmunity as a result of molecular mimicry. The aim of this study was to compare the level of IgG antibodies to a specific epitope (P1 peptide) of human heat shock protein (Hsp)60 homologous to Hp Hsp60 (HspB) in the sera of healthy donors (HD), patients with Hp-related gastritis or coronary heart disease (CHD), uninfected or with Hp infection confirmed by rapid urease test, histological examination (dyspeptic patients) the ¹³ C urea breath test (¹³ C UBT), and anti-Hp antibodies (healthy donors, CHD patients). The Anti-P1 IgG induction by Hp was verified by adsorption of sera with these bacteria and by experimental immunization of Caviae porcellus with Hp. Cytokine secretion by THP-1Blue™ monocytes in response to P1 was also assessed. Anti-P1 antibodies were detected in patients with gastritis or CHD infected with Hp and they were not found in uninfected individuals or asymptomatic carriers. No antibodies were raised against P2 in any group. Reduced cross-reactivity to P1 was exhibited by sera adsorbed with Hp. Caviae porcellus infected with Hp produced anti-P1 autoantibodies. THP-1XBlue™ monocytes responded to P1 by production of proinflammatory cytokines. Autoantibodies against P1 in Hp-positive patients with gastritis or CHD and upregulation of proinflammatory cytokines by P1 may contribute to the pathogenesis of Hp infection.

Evaluation of the impact of atmospheric pressure in different seasons on blood pressure in patients with arterial hypertension

OBJECTIVES

Atmospheric pressure is the most objective weather factor because regardless of if outdoors or indoors it affects all objects in the same way. The majority of previous studies have used the average daily values of atmospheric pressure in a bioclimatic analysis and have found no correlation with blood pressure changes. The main objective of our research was to assess the relationship between atmospheric pressure recorded with a frequency of 1 measurement per minute and the results of 24-h blood pressure monitoring in patients with treated hypertension in different seasons in the moderate climate of the City of Łódź (Poland).

MATERIAL AND METHODS

The study group consisted of 1662 patients, divided into 2 equal groups (due to a lower and higher average value of atmospheric pressure). Comparisons between blood pressure values in the 2 groups were performed using the Mann-Whitney U test.

RESULTS

We observed a significant difference in blood pressure recorded during the lower and higher range of atmospheric pressure: on the days of the spring months systolic (p = 0.043) and diastolic (p = 0.005) blood pressure, and at nights of the winter months systolic blood pressure (p = 0.013).

CONCLUSIONS

A significant inverse relationship between atmospheric pressure and blood pressure during the spring days and, only for systolic blood pressure, during winter nights was observed. Int J Occup Med Environ Health 2016;29(5):783-792.

Circumferential strain of carotid arteries does not differ between patients with advanced coronary artery disease and group without coronary stenoses

PURPOSE

Speckle tracking echocardiography is widely used for the analysis of myocardial function. Recently, circumferential strain (CS) of carotid arteries was postulated as novel indicator of vascular function. Our aim was to characterize and compare CS of carotid arteries in patients with advanced coronary artery disease and controls without significant coronary stenoses.

PATIENTS/METHODS

We compared CS of both common carotid arteries (CCA) in the 25 patients with three-vessel coronary artery disease (3VD) (mean age 69±9 years, 9 male) and in 16 age-matched subjects without significant coronary lesions (C) (69±8 years, 7 male). Additionally in 11 patients we estimated pulse wave velocity (PWV) and assessed the correlation between PWV and CS. Short-axis images of arteries were acquired for strain analysis with linear probe of echocardiograph. The assessment of CS was performed off-line by two observers.

RESULTS

The intraobserver variability for the CS (coefficient of variation) were 4.9 and 5.4% for left and right CCA and interobserver variability were 11.7% and 12.5%, respectively. The mean CS for left and right CCA did not differ between compared groups. We did not find correlation between CS strain and PWV. The only difference was related to the more prevalent plaque presence and thicker intima-media complex (IMT) in 3VD (p=0.0039 for IMT of left CCA and p=0.016 for IMT of right CCA).

CONCLUSIONS

The global CS of CCA, contrary to IMT, did not allow for differentiation between 3VD and C subjects. Despite good feasibility and concordance of CS measurements its clinical significance remains to be established.

Putative consequences of exposure to Helicobacter pylori infection in patients with coronary heart disease in terms of humoral immune response and inflammation

INTRODUCTION

Pathogens, including Helicobacter pylori (Hp), have been suggested to contribute to the development of coronary heart disease (CHD), although the evidence still remains insufficient. The study was focused on the exposure of CHD patients to Hp and resulting anti-Hp heat shock protein B HspB antibody production in relation to the level of serum lipopolysaccharide binding protein (LBP) as a marker of inflammation.

MATERIAL AND METHODS

One hundred seventy CHD patients and 58 non-CHD individuals participated in this study. Coronary angiography confirmed the atheromatic background of CHD. The panel of classical risk factors included: arterial hypertension, diabetes, total cholesterol, low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol, triglycerides, obesity and nicotinism. The Hp status was estimated by (13)C urea breath test and serology. Immunoblot and ELISA were used for screening the sera samples for anti-Hp HspB immunoglobulins (Igs) and LBP.

RESULTS

Coronary heart disease patients were exposed to Hp more frequently than non-CHD individuals. This was associated with increased levels of specific anti-Hp IgG2 and IgA as well as total IgA. Hp infected CHD and non-CHD donors produced anti-Hp HspB IgG cross-reacting with human Hsp 60. In CHD patients the LBP level was significantly higher in comparison to non-CHD donors. This was related to the severity of the disease. Type I Hp strains stimulated higher LBP levels than less pathogenic type II isolates.

CONCLUSIONS

Lipopolysaccharide binding protein secreted in excess together with anti-Hp HspB, cross-reacting with human Hsp60, may increase the risk of vascular pathologies in Hp-exposed CHD patients.

Correlation between the activity of the autonomic nervous system and endothelial function in patients with acute coronary syndrome

INTRODUCTION

The endothelium and sympathetic nervous system play an important role in the pathogenesis of acute coronary syndrome (ACS).

OBJECTIVES

The aim of our study was to evaluate correlations between noninvasive markers of the endothelial function and the sympathetic nervous system in patients with a recent ACS.

PATIENTS AND METHODS

The study included 52 patients who experienced an ACS within the previous 3 to 6 months. Endothelial function was expressed as the reactive hyperemia index (RHI), and the activity of the sympathetic nervous system--as latency and amplitude of sympathetic skin response (SSR) potentials from the 4 limbs. Linear and partial correlations between the RHI and SSR were calculated.

RESULTS

There were significant correlations between the RHI and the latency of the SSR in the upper limbs (r = 0.34, P = 0.02 for the right limb; and r = 0.34, P = 0.01 for the left limb). After eliminating the effects of age, sex, weight, and glomerular filtration rate, the partial correlation between the RHI and the latency of the SSR in the upper limbs remained statistically significant (r = 0.41, P = 0.004 for the right limb, and r = 0.42, P = 0.004 for the left limb). There was no correlation between the RHI and latency of the SSR during the stimulation of the lower limbs.

CONCLUSIONS

Our study confirmed the correlations between the sympathetic autonomic nervous system and endothelium in patients with ACS. The correlation of the RHI with the latency of the SSR was observed only in the upper limbs.

Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention

BACKGROUND

Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated with primary PCI in acute MI.

METHODS

This prospective study enrolled 538 patients who underwent primary PCI in acute MI. Admission blood samples were measured for MPV, PDW, and P-LCR. The patients were followed-up a mean period of 26 ± 11 months with regard to cardiac death, non-fatal reinfarction, re-PCI or coronary artery bypass grafting.

RESULTS

Kaplan-Meier survival analysis showed a significantly higher 26-month mortalityrate in patients with high MPV (≥ 11.7 fL) than in those with low MPV (< 11.7 fL) (14.6% vs. 5.5%, p = 0.0008). Similar findings were related to high P-LCR (≥ 38.1%) vs. low P-LCR (< 38.1%) - mortality 13.8% vs. 5.8%, p = 0.0025. Higher PDW values (≥ 16 fL) correlated with higher mortality rate as compared to PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint.

CONCLUSIONS

Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI.

Beneficial effects of cardiac rehabilitation in patients with incomplete revascularization after primary coronary angioplasty

BACKGROUND

There are no reliable data concerning the safety and benefits of physical rehabilitation in patients with a two-vessel disease before the second stage of angioplasty. The aim of this study was to evaluate the efficiency of early cardiac rehabilitation in patients with acute coronary syndromes and with angiographically significant residual coronary artery stenosis after a successful percutaneous coronary intervention (PCI) into the culprit lesion.

DESIGN

Retrospective analysis of the results of coronary angiograms and exercise tests of patients who underwent stationary rehabilitation after their first ACS and first PCI.

SETTING

Cardiac Rehabilitation Department.

POPULATION

One hundred ninety patients divided into 2 groups according to the completeness of myocardial revascularization; 49 with significant (≥70%) coronary artery stenosis in a non-culprit vessel, the mean diameter reduction 80±9%; and 141 without any residual stenosis. The prevalence of classical risk factors was comparable in both groups. Rehabilitation was conducted as a stationary 3-week program.

METHODS

Comparison of the initial and final exercise test workload in both groups, as well as the frequency of adverse effects during the program.

RESULTS

Physical training in patients with incomplete revascularization (IR) was safe and well tolerated. Significant increase of workload capacity after the rehabilitation program was observed in both groups: in the IR group from 7.3±3.0 to 8.8±2.9 MET (P<0.0001) and in the complete revascularization (CR) group - from 7.6±2.8 to 9.2±2.9 MET (P<0.0001). No significant difference was observed in initial workload capacities (P=0.9813) nor in final workload capacities (P=0.8571) between the two groups. Two patients in the group with residual lesion (4%) and one in the group without residual lesion (0.7%) required urgent PCI during the rehabilitation program, P=0.1637.

CONCLUSION

Early postinfarction physical training is safe and efficient for patients after complete revascularization and for those with untreated non-culprit coronary artery stenosis. Gradual increase in physical training intensity under cardiologist supervision is essential in identifying those rare patients for whom the second stage of angioplasty should not be delayed.

CLINICAL REHABILITATION IMPACT

Our study shows that patients with incomplete revascularization may be qualified for cardiac rehabilitation programs.

[One patient - many faces of myocardial ischaemia]

We present the case of a woman treated with coronary angioplasty due to non-ST segment elevation myocardial infarction,then again because of restenosis, who continued to complain of chest pain and syncope. Holter electrocardiogram recording revealed atrioventricular block related to ST-segment elevations and variant angina was diagnosed. Despite administered medications, the patient required pacemaker implantation.

Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers

INTRODUCTION

Long-lasting arterial hypertension causes left ventricular hypertrophy (LVH) and impairs left ventricular diastolic function. Our aim was to compare echocardiographic parameters between hypertensive patients defined as dippers and non-dippers during ambulatory blood pressure (BP) monitoring.

MATERIAL AND METHODS

We analysed 61 consecutive subjects with treated hypertension undergoing 24-h BP monitoring and transthoracic echocardiographic examination and included in the study patients with preserved left ventricular ejection fraction (EF ≥ 50%). Echocardiographic and arterial pressure parameters were compared between the group classified as dippers (n = 26, 57 ±13 years, 16 males) and non-dippers (n = 35, 60 ±12 years, 24 males) according to present or absent decrease of BP during the night > 10%. Echocardiographic data were compared between both groups and control subjects without hypertension.

RESULTS

Dippers had lower average systolic, diastolic and mean arterial pressure during the night hours but did not differ according to the mean pressure calculated from a 24-hour period. All echocardiographic parameters were similar in dippers and non-dippers. All patients with arterial hypertension presented with larger dimension of both ventricles and left atrium, thicker left ventricular walls, higher LV mass and mass index and preserved EF and E/A ratio as compared with normotensive controls. Normal geometry, concentric remodelling and eccentric hypertrophy were similarly distributed in both groups. Concentric hypertrophy was more prevalent in non-dippers as compared to the dippers (71.4% vs. 38.5%, p < 0.043).

CONCLUSIONS

The concentric type of LVH is the prevalent pattern in non-dippers. Non-dipping blood pressure pattern may be responsible for the development of left ventricular concentric hypertrophy secondary to hypertension.

Usefulness of extended holter ECG monitoring for serious arrhythmia detection in patients with heart failure and sleep apnea

BACKGROUND

In patients with systolic heart failure (HF), coexisting sleep apnea may promote arrhythmia. Ambulatory Holter electrocardiogram (ECG) monitoring (AECG) is a method of arrhythmia and apnea evaluation. We hypothesized that 24-hour AECG in patients with HF who have a high risk of serious arrhythmia may be less accurate than AECG extended to 48 hours and that, moreover, arrhythmia may be related to apnea.

METHODS

Eighty-four recordings of 48-hour AECG in 84 patients with ischemic HF (mean ejection fraction 34 ± 7%) were analyzed. Day 1, Day 2 were checked for ventricular tachycardia (VT) and supraventricular tachycardia (SVT). Estimated apnea-hypopnea index (est.AHI) was calculated using Holter, monitoring where est.AHI >15 indicates apnea.

RESULTS

In 48-hour AECG, VT occurred in 34 patients (40.5%) whereas SVT in 17 patients (20.2%), and patients with est.AHI > 15 had higher VT occurrence. In two-sample one-sided test for proportions, 24-hour AECG from Day 1 showed a significantly lower percentage of patients with detected VT than 48-hour AECG-it was 23.8% (20 patients), meaning a significant underestimation with P = 0.0089. We assessed VT underestimation in the subgroups with regard to est.AHI, and found that it was present in Day 1 monitoring in the subgroups with est.AHI > 15. It was absent in the subgroups with est.AHI ≤ 15 and also in Day 2 monitoring.

CONCLUSIONS

In patients with systolic HF, 24-hour AECG may have insufficient sensitivity regarding serious arrhythmia occurrence. If significant apnea was detected in the first day, extending the monitoring may be recommended.

Severe obesity impairs systolic and diastolic heart function - the significance of pulsed tissue Doppler, strain, and strain rate parameters

BACKGROUND

We assessed the impact of morbid obesity on systolic and diastolic heart function in severely obese, but otherwise healthy subjects and age-matched controls.

METHODS

Overall, 27 obese patients: 19 female (F) and 8 male (M) mean age 37 ± 9, mean body mass index (BMI) 46 ± 6 and 27 control subjects: mean age 36 ± 10, mean BMI 23 ± 3 were examined by transthoracic echocardiography, including tissue Doppler echocardiographic (TDE) assessment and speckle tracking echocardiography to measure left ventricular longitudinal, circumferential, and radial strain (S) and strain rate (SR) during systolic and early diastolic phase.

RESULTS

Obese patients presented with enlargement of both ventricles and the left atrium, and thicker left ventricular wall. Although left ventricular ejection fraction (EF) as well as amplitude of tricuspid annulus plane systolic excursion (TAPSE) was similar, the amplitude of mitral annulus plane systolic excursion (MAPSE) and ventricular systolic and early diastolic velocities measured by TDE were significantly lower for both ventricles in the obese group. (RV S' 13 ± 3 cm/sec vs. 15 ± 2 cm/sec, P = 0.0057; LV S' lat 8.5 ± 1.6 cm/sec vs. 12.1 ± 2.8, P < 0.0001, E' lat: 12.4 ± 2.9 vs. 16.4 ± 3.5 cm/sec for left ventricular and E' 12 ± 3 cm/sec vs. 18 ± 4 for right ventricular velocities, P < 0.0001). Among the deformation parameters, systolic and diastolic circumferential and systolic radial strain and SR were decreased in the obese subjects, whereas longitudinal strain did not differ significantly.

CONCLUSIONS

TDE parameters documented reduced systolic and diastolic function of both ventricles in obese patients. 2-dimensional speckle tracking analysis revealed that circumferential and radial but not longitudinal strain and SR were impaired in the obese group.

Presence of coronary collaterals in ST-elevation myocardial infarction patients does not affect long-term outcome

INTRODUCTION

The significance of coronary collateral circulation in the prognosis of patients after myocardial infarction remains disputable.

OBJECTIVES

The aim of the study was to evaluate the effect of coronary collateral circulation, assessed by the Rentrop score, on long-term prognosis in patients treated with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI).

PATIENTS AND METHODS

Coronary collateral flow was assessed by angiography in 330 patients with myocardial infarction using the Rentrop score. Patients were followed up for the mean period of 26 ±12 months with the clinical endpoints of cardiac death, nonfatal reinfarction, and repeat percutaneous or surgical revascularization.

RESULTS

 Collateral circulation was graded Rentrop 0 in 39%, Rentrop 1 in 36%, Rentrop 2 in 18%, and Rentrop 3 in 7% of the patients. The mortality rate was 8.7%. Reinfarction occurred in 4.7% of the subjects, and repeat coronary revascularization was performed in 10.9% of the patients. These endpoints were not correlated with the degree of collateral circulation. A significant inverse association was observed between the Rentrop score and the infarct-related artery antegrade flow (P <0.001).

CONCLUSIONS

The degree of collateral circulation assessed by the Rentrop score during primary PCI is not a useful long-term prognostic factor in the population with STEMI in the current therapeutic approach. This may result from the negative correlation between the Rentrop score and the degree of blood flow in the infarct-related artery. Thus, collateral circulation in a patient with STEMI should not discourage intensive cardiovascular risk factor control in secondary prevention of coronary artery disease.

Helicobacter pylori antigens as potential modulators of lymphocytes' cytotoxic activity

Helicobacter pylori (H.p) colonizes human gastric mucosa and causes gastric and duodenal ulcer disease or gastric cancer. Various H.p compounds may modulate the host immune response in regards to tolerance of the infection or disease development. The aim of this study was to determine whether H.p lipopolysaccharide (LPS) and glycine acid extract antigens (GE) or E. coli LPS influence the cytotoxic activity of peripheral blood lymphocytes from H.p infected - H.p (+) or uninfected - H.p (-) individuals, in the presence or absence of exogenous interleukin (IL)12. Individual H.p status was defined by the urea breath test. Lymphocytes, stimulated or not with H.p, and control antigens, with or without IL-12, were used as effector cells and epithelial HeLa cells as targets. The cytotoxicity of lymphocytes was expressed as the percentage of dead target cells unable to reduce tetrazolium salt. The supernatants from HeLa/lymphocyte cultures were used for detection of the cellular cytotoxicity markers granzyme B and caspase 8. The natural cytotoxic activity of lymphocytes from H.p (+) was less than that of H.p (-) donors. This may have been due to fewer natural killer cells of CD3(-) CD56(+) Nkp46(+) phenotype in H.p (+) in comparison to H.p (-) subjects. H.p GE and standard E. coli LPS enhanced the cytotoxicity of lymphocytes towards target cells whereas H.p LPS downregulated this activity. The decrease in lymphocyte cytotoxicity in response to H.p LPS correlated with a lack of IL-2 and IL-12 production, inhibition of interferon-γ production, and low IL-10 secretion by mononuclear leukocytes. IL-12 significantly enhanced the natural as well as H.p LPS and H.p GE driven cytotoxic capacity of lymphocytes. In conclusion, H.p LPS may negatively modulate natural cytotoxic activity and cytokine secretion by immunocompetent cells and thus be involved in the maintenance of infection and development of gastric pathologies.

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring (ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure (BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients’ BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular (CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different age groups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.

Melatonin - a somniferous option which does not aggravate sleep-disordered breathing in cardiac risk patients: a Holter ECG based study

BACKGROUND AND AIM

We hypothesised that melatonin may represent a safe somniferous drug for cardiac patients, and assessed the effects of administering 5 mg of melatonin daily before bedtime for 30 days in patients with coronary artery disease (CAD) regarding changes in the nocturnal breathing pattern.

METHODS

Sixty patients with CAD (aged 48-80 years) were randomised to melatonin/placebo treatment in a 2:1 ratio. A Holter ECG-based method (Lifescreen Apnea software) which has been validated as a screening tool for sleep-disordered breathing was used to estimate the apnoea/hypopnoea index (AHI). A 24-h Holter ECG was used to detect nocturnal breathing abnormalities at the beginning and at the end of the observation. The values of estimated AHI (eAHI) ≤ 15 were classified as optimal (Opt) and those 〉 15 - as pathological (Pat). A change of the breathing pattern was classified on the basis of the transition between the initial and final eAHI status (Opt→Opt; Opt→Pat; Pat→Pat, Pat→Opt). The mean initial and final value of eAHI and the percent of Opt and Pat values of eAHI in the initial and final assessment were compared between the melatonin and the placebo groups.

RESULTS

The breathing pattern was not affected by melatonin - the mean initial value of the eAHI in the melatonin group was 18.2 ± 9.4, and in the placebo group 19.6 ± 12.3 (p = 0.64), whereas at the end of the observation in the melatonin group it increased by 1.2 ± 11.3, and in the placebo group - by 1.0 ± 9.0 (p = 0.44).

CONCLUSIONS

Hypnagogic treatment with melatonin did not worsen the eAHI in patients with CAD.

The prevalence and the prognostic value of microvolt T-wave alternans in patients with hypertrophic cardiomyopathy

BACKGROUND

Nonsustained ventricular tachycardia (nVT) may have ominous implications for patients with hypertrophic cardiomyopathy (HCM). The microvolt T-wave alternans (TWA) has been proposed as a noninvasive tool-identifying patients at risk of sudden cardiac death and ventricular tachycardia/fibrillation (VT/VF). The aim of the study was to determine the significance of TWA in predicting nVT episodes and compare how other electrocardiographic parameters can predict the occurrence of nVT.

METHODS

The study group consisted of 88 patients with HCM. TWA was assessed during exercise test using the CH2000 system. All patients underwent Holter monitoring (HM) within 2-4 weeks before TWA test (preexercise HM1) and immediately after (postexercise HM2). During HM, we analyzed: arrhythmias, QT intervals, the presence of late ventricular potentials (LP), heart rate variability, heart rate turbulence.

RESULTS

Depending on TWA results, the patients were divided into two groups: TWA+; 46 patients (52.3%) with positive/indeterminate results, and TWA-; 42 patients (47.7%) with negative results. The nVT episodes were more frequent among TWA(+) both in HM1 and HM2. The presence of TWA increases the risk of postexercise nVT over twenty times (OR = 21.03). Moreover, in HM1, QTc and LP, and in HM2, again QTc and N-terminal precursor of brain natriuretic peptide proved to be significant predictors of nVT. The addition of TWA to the models did not improve the arrhythmia risk assessment.

CONCLUSIONS

Repolarization abnormality plays an important role in generating nVT in patients with HCM, but TWA does not specifically predict the risk of arrhythmic end point.

Repeatability of sleep apnea detection in 48-hour holter ECG monitoring

BACKGROUND

There is a significant relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. Reliability of new methods evaluating apnea in Holter ECG monitoring is still the matter of investigators' studies.

METHODS

In 48-hour Holter ECG monitoring recordings of 63 patients, we assessed repeatability, comparing the results from both sleep periods.

RESULTS

We found good repeatability in evaluation of apnea-hypopnea index value. There was moderate agreement in three categories, that is, normal or bordeline or apneic assignment. Assignment to "healthy" (normal and borderline) or apneic subgroup during consecutive sleep periods showed high repeatability.

CONCLUSIONS

Holter ECG monitoring is a repetitive method of preliminary diagnosis in patients evaluated for sleep apnea syndrome.

Ivabradine as a heart rate-lowering agent in a patient with end-stage renal failure after heart transplantation

A 56 year-old woman with a transplanted heart, with arterial hypertension and chronic pulmonary obstructive disease, was hospitalised because of palpitations, dyspnea, chest pain and oedema. After cyclosporine treatment she was diagnosed with renal failure, which was treated by hemodialysis. Heart rate (HR) at admission was 100, mean HR in 24-hour Holter monitoring was 106 bpm. Ivabradine was added to the treatment. The dose of 2.5 mg bid was doubled after three days. Mean HR in control Holter monitoring was 81. Ivabradine was well tolerated in this patient. The clinical benefits were observed soon after application and maintained during the follow-up.

Acute myocardial infarction as the first presentation of thyrotoxicosis in a 31-year old woman - case report

A 31-year old woman, previously fit & well was admitted with pressing retrosternal chest pain and palpitations of sudden onset. Her body weight was normal (BMI 20.5 kg/m²) and there was no significant family history of cardiac disease. She smoked, however, about 15 cigarettes a day and she had been taking combined oral contraceptive pill (Cilest^®) for about three years. On admission she appeared sweaty and in pain, blood pressure 130/70 mmHg, heart rate about 110/min, mild lid-lag sign. Heart sounds were normal and chest was clear. ECG revealed 2-3 mm ST segment elevations in II, III, aVF as well as V2 to V5. Troponin I was raised and she was qualified to an emergency coronary angiography. This revealed a massive spasm of left anterior descending (LAD) coronary artery that responded to intracoronary glyceryl trinitrite administration, however, with the presence of critical narrowing of the LAD apical segment with possible superimposed thrombus. Cardiac ultrasound revealed akinesis of 1/2 of apical area consistent with myocardial infarction

Treatment and progress

She was started on Aspirin, Simvastatin, and Diltiazem, but continued to have persistent tachycardia and tremor. Thyroid function tests were ordered and showed thyrotoxicosis [free T4-46.9 pmol/l (ref. range 9-25), free T3-11.9 pmol/l (2-5), TSH - 0.02 mIU/l (0.27-4.2)]. She was referred for an endocrine opinion and started on Thiamazole. Other investigations revealed elevated anti-TPO and anti-TSH receptor antibodies consistent with Graves' disease. Thrombophilia screen was negative. She had remained euthyroid on a "block & replace" regimen (Thiamazole plus L-Thyroxine) that was discontinued after 18 months. She denies any anginal symptoms, but continues to smoke against medical advice.

Conclusions

Our case highlights the possibility of development of an acute myocardial infarction in a young subject with thyrotoxicosis. We speculate that patient's smoking habit combined with subtle thyrotoxicosis-induced prothrombotic state and/or coronary-artery spasm had lead to the above-mentioned acute coronary event.

The effects of intracoronary autologous mononuclear bone marrow cell transplantation on cardiac arrhythmia and heart rate variability

BACKGROUND

The results of stem cell therapy after myocardial infarction (MI) have been conflicting. The effects of this therapy on ventricular arrhythmias and autonomic control of heart rate have not yet been established.

AIM

To assess the effects of bone marrow cell (BMC) transplantation on the occurrence of arrhythmias and heart rate variability (HRV) parameters in short-term observation after ST-elevation myocardial infarction (STEMI).

METHODS

Sixty patients with STEMI who underwent primary PCI, were randomly assigned to two groups: Group 1 - 36 patients selected for active treatment (autologous BMC, intracoronary injection mean 7 days after STEMI), and Group 2 - 24 control patients not treated with BMC transplantation. In all patients the infarct-related artery was the left anterior descending, and the left ventricular ejection fraction was < 40%. Two Holter sessions were performed: at baseline (HM1), on average 6 days after MI, and another one (HM2), 1 month after BMC implantation. From these recordings the frequency of non-sustained ventricular tachycardia (nsVT) episodes and the parameters of HRV were calculated.

RESULTS

Both groups were comparable with regard to demographic data, the presence of risk factors and electrocardiographic parameters. In HM2 examination the frequency of nsVT tended to be higher in Group 1 (25 vs. 12.5%, NS). The HRV analysis showed lower HF and significant SDNN increase in the BMC group. In controls all the HRV parameters increased. The increase in HF was significantly lower in the BMC group than in controls (22.4 vs. 89.2 ms(2), p $lt 0.011).

CONCLUSIONS

1. During the first month after the intracoronary injection of BMC, non-significant increase of nsVT was observed. 2. The lack of significant increase in HF power after BMC infusion may be a sign of depressed parasympathetic tone.

Interleukin-1b and interleukin-1 receptor inhibitor gene cluster polymorphisms in patients with coronary artery disease after percutaneous angioplasty or coronary artery bypass grafting

BACKGROUND

Pro-inflammatory cytokine interleukin-1b (IL-1b) plays a role in atherosclerosis. The results of several studies on the association between polymorphism of the IL-1b gene cluster and the course of coronary atherosclerosis have been inconclusive.

AIM

To investigate retrospectively whether the patients with the most common variants of polymorphism of the IL-1b gene cluster differ with respect to localisation and extent of coronary atherosclerosis to a degree which may influence the treatment strategy.

METHODS

Ninety-two consecutive out-patients (age 39-83, male sex 74%) with coronary artery disease confirmed by angiography were included. In this group, 23 patients underwent coronary artery bypass grafting (CABG) and 69 percutaneous coronary interventions (PCI) of whom in 16 repeated treatment was performed. The polymorphisms of the IL-1b gene - transition C/T at -511 and -31 position - as well as of the IL-1 receptor antagonist gene (IL-1RN) - an 86-base pair variable-number tandem repeat in intron 2 - were determined by PCR. Out of the 54 theoretically possible combinations of polymorphisms, 17 were found in the studied group. The three most common combinations of polymorphisms were selected. The fraction of patients treated by means of primary or elective percutaneous coronary intervention (pPCI, ePCI) and by means of CABG were compared between the subgroups with one of the 3 most common combinations of polymorphisms.

RESULTS

The most frequent combinations of polymorphisms were - Variant A: -31 C/T, -511C/T, RN 1/1 - 32.6%; Variant B: -31T/T, -511C/C, RN 1/1 - 27.1%; Variant C: -31C/T, -11C/T, RN 1/2 - 10.8%. The remaining patients (29.5%) represented 14 variants present in very small subgroups consisting only of 1, 2 or 3 persons. Statistical analysis showed that patients with the second most common variant of studied polymorphisms (variant B) were significantly more frequently treated with CABG in comparison to the two other variants. Also, repeated PCI was most frequent in this subgroup.

CONCLUSION

The data presented here suggest that carriers of the two relatively frequent variants of the IL-1b gene at -31 and -511 position, i.e. -31TT and -511CC, are at a higher risk of developing coronary artery disease requiring surgical treatment or two-stage percutaneous angioplasty.

Myocardial infarction in young people

An estimated 6 to 10% of myocardial infarctions occur in patients under the age of 45. Usually this applies to men, but an increasing prevalence is being observed among women. Atherosclerosis, often one vessel disease, is the main cause. The presence of classic risk factors affects the dynamics of coronary artery disease: the strongest risk factor is smoking, regardless of gender. Environmental influence is also possible. No atherosclerosis is found in 20% of young patients. In such cases, the most frequent mechanisms of ischemia are: coronary artery embolism (5%), thrombosis (5%), anomalies (4%) and inflammation or spasm of the vessel. Age is an independent prognostic factor. Thus the clinical outcome after myocardial infarction is better in younger than in older patients.

Relationship between echocardiographic parameters and exercise test duration in patients after myocardial infarction

BACKGROUND

The interdependence between echocardiographic parameters of left ventricle function, severity of heart failure (HF) and exercise test duration has not been thoroughly examined.

METHODS

We compared echocardiographic data in patients after myocardial infarction divided according to NYHA class to mild (class I and II, group 1 = 24 subjects) and advanced HF group (III and IV, group 2 = 36) and assessed their correlation with exercise duration (ED) in a symptom-limited treadmill test. Then we tried to determine independent predictors of ED.

RESULTS

The group with advanced HF had lower left ventricle ejection fraction, shorter duration and deceleration times of both mitral inflow waves (Et and At, Edt and Adt) and higher E/A ratio (1.4 +/- 1.1 vs. 0.9 +/- 0.4; p < 0.05) with more frequent restriction and pseudonormalization pattern (56% vs. 12%). Also early wave propagation (21 +/- 7 vs. 29 +/- 11 cm/s; p < 0.001) and all tissue Doppler velocities were lower, but ratio of early wave peak velocity to early diastolic velocity of mitral annulus was higher (E/E' 10.5 +/- 5 vs. 6.1 +/- 1.3 for velocity ratio; p < 0.001) in subjects with more severe clinical symptoms. Significant negative correlation with ED was observed for difference between duration of pulmonary vein atrial reversal flow and atrial wave of mitral inflow (DeltaAt; r = -0.54) and for E/E' ratio (r = -0.48), the highest positive correlation for left ventricular ejection fraction and duration of mitral inflow atrial phase (EF; r = 0.48, At; r = 0.46). In multivariate stepwise regression analysis two independent predictors of ED were identified: age and DeltaAt (Art-At).

CONCLUSIONS

Diastolic parameters showing the strongest correlation with ED (DeltaAt and E/E') are connected with restrictive left ventricle physiology. The only independent predictors of exercise duration in patients after myocardial infarction were: age and DeltaAt.

Heart rate turbulence in patients with chronic heart failure

BACKGROUND

Heart rate turbulence (HRT) has been shown to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with chronic heart failure (CHF) has not yet been well established.

AIM

To evaluate HRT in patients with CHF and assess the prognostic significance of HRT in this group.

METHODS

The study group consisted of 82 patients with CHF and left ventricular ejection fraction (LVEF) <35%. All the patients underwent 24-hour Holter monitoring (HM). The heart rate variability (HRV) and HRT parameters were assessed using HRT view software. Two HRT parameters - turbulence slope (TS) and turbulence onset (TO), were calculated. We analysed the clinical course and survival during a two-year follow-up (mean 25+/-9 months).

RESULTS

The patients were divided into three groups according to the HRT parameters. Group 1 (23 patients) with both normal TO and TS (TO <0%, TS >2.5 m/s), group 2 (30 patients) with abnormal TO or TS, group 3 (29 patients) with abnormal TO and TS (TO >0% and TS <2.5 m/s). Patients from group 1 was significantly younger. There were no differences between patients in aetiology, treatment and the frequency of ventricular premature beats. Significant correlations between HRV and HRT parameters were observed. The correlation was the strongest between TS and SDNN and LF. During the follow-up 9 patients died and 15 were hospitalised for non-fatal infarction or worsening of CHF. Using a multivariate logistic regression model, it was shown that TS <2.5 ms/RR interval, and non-sustained ventricular tachycardia (VT) significantly increased the risk of a serious cardiac events in CHF patients.

CONCLUSION

HRT parameters are often abnormal in patients with CHF. An abnormal turbulence slope (TS) and VT episodes are significantly associated with increased risk of cardiac complications in CHF.

Enlarged left atrium is a simple and strong predictor of poor prognosis in patients after myocardial infarction

BACKGROUND AND AIM

Patients after myocardial infarction (MI) differ according to the extend of myocardial damage and prognosis. Diastolic function impairment may have great impact on development of heart failure and outcomes. We evaluated the prognostic value of various echocardiographic measurements in 18-month and 3-year observation after MI.

METHODS

60 patients after MI (44 male, mean age 60 +/- 11) were examined by transthoracic echocardiography with the assessment of wide spectrum of parameters. Mortality and combined end points (cardiac deaths and heart failure exacerbation) were assessed after 18-month and 3-year observation and groups with and without end points were compared. Optimal cutoff values were estimated by receiver operating characteristic (ROC) analysis and resulting Kaplan-Meier curves were compared.

RESULTS AND CONCLUSIONS

After 18 months, 11 deaths occurred and 20 subjects experienced hospitalization caused by heart failure exacerbation. Although the group with cardiac events showed a greater enlargement of the left ventricle and lower ejection fraction, the highest relative risk of poor outcome (RR = 5.0) was related to the left atrial enlargement above 44 mm. Although restrictive or pseudonormal inflows were connected with 2.1 relative risk of combined end point, all patients with E deceleration time < or = 130 ms experienced heart failure exacerbation or death. Despite tissue Doppler and propagation parameters describing elevated end-diastolic pressure differed between groups with various outcomes in multivariate analysis, only enlarged left atrium was an independent predictor for both combined end point and cardiac death. Further 3-year follow-up solely confirmed the role of above described predictors.

Anti-phagocytic activity of Helicobacter pylori lipopolysaccharide (LPS)--possible modulation of the innate immune response to these bacteria

The Helicobacter pylori infections are followed by an infiltration of the gastric mucosa by neutrophils and macrophages. Accumulation of phagocytes enables them to interact with H. pylori, but a great number of infected subjects cannot eradicate these bacteria. The H. pylori inhibits its own uptake by blocking the function of phagocytes. The anti-phagocytic mechanism depends on bacterial surface structures and the presence of the cag pathogenicity island (PAI). The role of H. pylori lipopolysaccharide (LPS), during phagocytosis of these bacteria is not clear. LPS may mediate direct bacteria/phagocyte interactions and it may also regulate antibacterial activity of the phagocytes. In this study we investigated the influence of H. pylori LPS on phagocytosis of these bacteria. The H. pylori LPS inhibited an ingestion of these microbes by human peripheral blood granulocytes. This was correlated with a diminished ability of phagocytes to reduce MTT-tetrazolium salt. The anti-phagocytic effect of H. pylori LPS was reduced by recombinant lipopolysaccharide binding protein (rLBP). It is possible that in vivo H. pylori LPS may diminish elimination of these bacteria from the gastric mucosa promoting an infection persistence. However, LBP may modulate the uptake of H. pylori due to neutralization of anti-phagocytic effect of its LPS.

[Severe valvular aortic stenosis in a 78-year-old woman]

We present a case of a 78-year-old woman with severe valvular aortic stenosis which was diagnosed for the first time ever in our department despite the patient having been treated by general practitioners for several years because of diabetes mellitus. The patient complained of recurrent syncope, effort dyspnea and angina. During echocardiographic evaluation calcified stenotic aortic valve with extremely high maximal aortic gradient (199 mmHg) was found. The patient was qualified for surgical intervention. She died several hours after aortic valve replacement because of an acute aortic rupture and massive pericardial bleeding.

The relationship between heart rate variability and heart rate turbulence dynamics after primary coronary angioplasty

BACKGROUND

The application of heart rate turbulence (HRT) analysis for risk assessment after pharmacologically treated myocardial infarction (MI) was described in 1999. The aim of the present study was to evaluate the dynamics of HRT changes in long-term observation after MI treated with primary coronary angioplasty (PTCA). Moreover, the usefulness was assessed of early postinfarction heart rate variability (HRV) analysis for predicting HRT dynamics.

METHODS

The study group consisted of 96 patients with MI treated with primary PTCA. Holter monitoring with HRV and HRT analysis was performed 3 days after the procedure and 1 year later.

RESULTS

Twelve months after primary PTCA, an improvement (Type I HRT dynamics) was noted in 51 patients, and the worsening of both the HRT parameters (Type II HRT dynamics) in 34 patients. Fourteen patients showed the worsening of only one HRT parameter (Type III HRT dynamics). The following HRV parameters recorded in early postinfarction Holter monitoring had a significant influence on the risk of Type II HRT dynamics: SDNN, RMSSD, Triangle Index and Delta LF/HF (mean day-time LF/HF - mean night-time LF/HF). Only the latter was found in the multivariate analysis as significantly connected with worsened HRT. During the follow-up, SDNN and Triangular Index improved in all the patients.

CONCLUSIONS

HRT after myocardial infarction treated with primary PTCA presents a significant dynamics, which is different than dynamics of HRV. An abnormal circadian pattern of autonomic activity is a finding that helps identify patients who need to have HRT analysis repeated during a long-term follow-up, due to the tendency for HRT to change with time toward the prognostically unfavorable values.