128 research outputs found

    Atrial fibrillation in patients with atrial septal aneurysm

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    Background: To assess the incidence of paroxysmal atrial fibrillation (AF) in patients with atrial septal aneurysm (ASA) and the relationship between ASA morphology and the incidence of AF. Methods: Among 12,941 patients evaluated echocardiographically, 88 (0.68%) were diagnosed with ASA [with 35 (39.8%) males and 53 (60.2%) females; mean age, 54.3 &#177; 14.4 years]. The morphology of the aneurysm and the atria was evaluated by echocardiography, P wave dispersion was evaluated by 12-lead electrocardiography (ECG) and the presence of AF was confirmed by 24-hour ambulatory ECG monitoring. ASA was diagnosed when the base of the aneurysm on echocardiography exceeded 15 mm and its protrusion exceeded 7.5 mm. Results: Paroxysmal AF was documented in 15 (17.0%) patients with ASA. We showed that the presence of AF depended on the area of the aneurysm, with the latter positively correlating with the area of the left atrium. We further found a significant relationship between the presence of atrial arrhythmia and the dispersion of P wave duration (p < 0.005). The remaining characteristics, such as gender and age, embolic events, interatrial shunt and comorbidities showed no correlation with the occurrence of AF. Conclusions: The occurrence of paroxysmal AF in patients with ASA depends on the area of the aneurysm and the increased area of the left atrium. Patients with ASA and paroxysmal AF display a significantly higher dispersion of sinus P wave duration versus patients with ASA but without paroxysmal AF. The presence of ASA structure oscillation, the direction of aneurismal protrusion and the presence of interatrial shunt do not significantly affect the incidence of AF. (Cardiol J 2007; 14: 580-584)

    Prewencja kardiologiczna

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    Gender-related benefit of transport to primary angioplasty: Is it equal?

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    Background. Infarct size is correlated with duration of coronary artery occlusion. Evidence suggests that transport for primary angioplasty improves outcomes, but there is no agreement regarding differences in prognosis between men and women. We compared outcomes in men and women with ST-segment elevation myocardial infarction (STEMI) transferred from another hospital against those who had been transported directly to an invasive treatment center. Methods. Data was collected between June 2005 and May 2006 from a registry of 26,035 patients with STEMI and in whom primary angioplasty had been performed. Results. A total of 10,708 patients underwent primary angioplasty. Of these, 3,359 men and 1,469 women were transported directly, while 4,135 men and 1,745 women were transferred from another site. In-hospital mortality and at one month, six months and 12 months after hospital discharge was significantly higher in women than in men. The prognosis of women transported directly was similar to that of women transferred from another site. However, there was a tendency, albeit insignificant, towards higher mortality at six and 12 months in women transported from another hospital. Conclusions. To reduce mortality in STEMI, an immediate reperfusion must not be delayed. This conclusion is valid particularly for women who are at greater risk of death. (Cardiol J 2011; 18, 3: 254&#8211;260

    Acute myocardial infarction due to left main coronary artery disease: A large multicenter national registry

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    Background: Optimal management of patients with acute myocardial infarction (MI) dueto critical stenosis of an unprotected left main coronary artery (ULMCA) is not established.However, data from observational studies and registries encourage to perform percutaneouscoronary intervention (PCI) in high risk patients. We investigated gender-related discrepancies,clinical course and prognosis in patients with acute MI and ULMCA as an infarct-relatedartery.Methods: A total of 643 consecutive patients (184 [28.6%] females and 459 [71.4%] males)with acute MI due to critical ULMCA stenosis were selected from the population of 121,526patients hospitalized due to acute coronary syndromes between 2003 and 2006. The primaryendpoints were in-hospital, 30-day, 6-month and 12-month mortality.Results: Women were older than men with signifi cantly higher proportion of women olderthan 65 and with unfavorable risk profi le. The management in men and women was similar.There was no signifi cant gender-related differences in mortality in all follow-up periods. Inmultivariate analysis cardiogenic shock, pulmonary edema, ST elevation myocardial infarction(STEMI) and advanced age signifi cantly increased mortality, whereas successful PCIdecreased mortality.Conclusions: No signifi cant differences in clinical course, treatment and prognosis betweenmen and women were noted. Mortality remained very high in both genders. The most unfavorableprognostic factors were cardiogenic shock, pulmonary edema, STEMI and advancedage. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset ofpatients

    Safety of dental extractions in patients on dual antiplatelet therapy : a meta-analysis

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    Introduction: Safety of dental extractions in patients on chronic antiplatelet therapy either with only acetylsalicylic acid (ASA) or clopidogrel or with both combined has been a matter of debate, with no clearly conclusive studies published. Aim: To perform a meta-analysis of published observational studies in order to study the effect of single and double antiplatelet therapy in comparison to controls on the occurrence of immediate local bleeding complications during dental extractions. Material and methods: PubMed/Scopus/Embase database search revealed 22 papers (13 original and 9 review), 3 of which were finally included in the meta-analysis. Phrases searched: dual[All Fields] AND antiplatelet[All Fields] AND (“therapy”[Subheading] OR “therapy”[All Fields] OR “therapeutics”[MeSH Terms] OR “therapeutics”[All Fields]) AND (“tooth extraction”[MeSH Terms] OR (“tooth”[All Fields] AND “extraction”[All Fields]) OR “tooth extraction”[All Fields]). Results: The overall event incidence (bleeding complication after extraction) in the entire population was 1.59% (42 events in 2637 patients). As compared to the control group, the use of double antiplatelet therapy DAPT was associated with on odd ratio OR of 40.23 (95% CI: 4.37–370.36) increase in risk of bleeding events occurrence (p = 0.0011). Significant heterogeneity was observed (p < 0.001; I2 of 76.7%). Conclusions: Dental extractions following strict procedural protocols in patients on double antiplatelet therapy with clopidogrel and ASA are associated with an additional risk of immediate local bleeding complications

    Does permanent cardiac stimulation through atrial natriuretic peptide secretion influence the basic parameters of renal function?

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    Background: The aim of this study was to evaluate atrial humoral function and renal function after pacemaker implantation due to atrioventricular conduction disturbances. We analyzed blood atrial natriuretic peptide (ANP) concentration and basic parameters of renal function within 1 month of implantation of VVI and DDD pacemakers. We evaluated correlations between blood ANP values and basic renal function parameters. Methods: We studied two groups of patients with atrioventricular (AV) conduction disturbances: second-degree AV block and third-degree AV block. Group I comprised 20 patients aged 71-90 years (median 77.5 &#177; 5.9 years) in whom permanent VVI pacing was applied, and group II consisted of 20 subjects aged 49-81 years (median 68.9 &#177; 11.9 years) in whom DDD/ /VDD pacemakers were implanted. The control group consisted of 15 healthy volunteers aged 58-80 years (median 72.7 &#177; 2.8 years). Plasma concentration of ANP was determined by radioimmunoassay. The parameters of renal function we analyzed with Jaffe&#8217;s colorimetric and kinetic test. Results: Patients in group I showed a significant decrease in blood concentration of ANP from 168.1 &#177; 81.9 pg/1000 mL to 118.0 &#177; 61.1 pg/1000 mL (p < 0.01) 7 days after implantation. At 30 days, ANP was 121.4 &#177; 71.9 pg/1000 mL. In group II, plasma concentration of ANP decreased significantly from 134.9 &#177; 8.1 pg/1000 mL to 104.9 &#177; 6.1 pg/1000 mL (p < 0.01) 7 days after implantation and to 110.8 &#177; 53.3 pg/1000 mL at 30 days. Patients in group I had elevated, albeit insignificantly, clearance of creatinine to 76.1 &#177; 17.8 ml/min at 7 days (p > 0.05) which increased significantly to 85.0 &#177; 17.9 ml/min at 30 days. In group II, clearance of creatinine increased insignificantly to 84.6 &#177; 13.2 ml/min (p < 0.05) at 7 days and was significantly elevated to 96.9 &#177; 18.2 ml/min (p < 0.05) at 30 days. In group I, plasma concentration of creatinine decreased significantly (p < 0.05) to 1.15 &#177; 0.30 mg/dl at 7 days and to 1.01 &#177; &#177; 0.21 mg/dl at 30 days. In group II, there was a significant decrease (p < 0.05) to 1.15 &#177; 0.24 mg/dl at 7 days and to 1.08 &#177; 0.27 mg/dl at 30 days. There was a positive correlation between creatinine clearance and plasma ANP concentration in groups I and II (r = 0.301; p < 0.05). Conclusions: In patients with a pacemaker implanted due to atrioventricular disturbances, blood concentration of ANP was decreased. Renal function was improved after pacemaker implantation. (Cardiol J 2007; 14: 568-572)

    Myocardial infarction in a low risk patient with hereditary hemorrhagic telangiectasia

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    We describe the case of a 57 year-old woman with NSTE ACS, a history of recurrent and prolonged epistaxis, and low prior cardiovascular risk. Additional findings revealed anemia and an aneurysm in her central nervous system. During her hospital stay, hereditary hemorrhagic telangiectasia (HHT) was diagnosed. After application of two antiplatelet drugs, the patient was scheduled for coronarography, followed by coronary artery bypass grafting. During her hospital stay, only a minor episode of epistaxis was observed. We conclude that anemization due to HTT may significantly accelerate the progress of ischemic heart disease, resulting in acute coronary syndrome. Moreover, coronarography preceded by routine application of two antiplatelet drugs seems not to increase the risk of hemorrhage in HHT patients complicated with myocardial infarction. (Cardiol J 2010; 17, 2: 189-191

    Correlation analysis of atrial natriuretic peptide concentration, echocardiographic left atrial and left ventricular dimensions, and renal function parameters in patients after permanent pacemaker implantation

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    Background: Atrial endocrine function was established in the second half of the 20th century, confirming the role of artial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the physiology of the cardiovascular system. The present study was undertaken to evaluate changes in ANP and echocardiographic parameters within the first month after VVI and DDD pacemaker implantation and to evaluate correlations between the parameters. Methods: The study population consisted of group I - 20 VVI patients aged 71-90 years (mean age 77.5 &#177; 5.9) and group II - 20 DDD/VDD patients aged 49-81 years (mean age 68.9 &#177; 11). Fifteen healthy volunteers aged 58&#8211;80 years (mean age 72.7 &#177; 2.8) served as controls. Correlations between ANP levels and cardiac cavity dimensions and between ANP and parameters of renal function were studied. Results: Blood levels of ANP decreased after pacemaker implantation: in the VVI group from 168.61 &#177; 81.95 pg/1000 &#956;L to 118.04 &#177; 61.06 pg/1000 &#956;L at 7 days and to 121.4 &#177; 71.90 pg/1000 &#956;L at 30 days; and in the DDD/VDD group from 134.89 &#177; 83.11 pg/1000 &#956;L to 104.96 &#177; &#177; 57.09 pg/1000 &#956;L at 7 days and to 110.82 &#177; 53.32 pg/1000 &#956;L at 30 days. There was a significant correlation between ANP levels and left atrial size in the DDD/VDD group - 0.598 (p = 0.005) and 0.593 (p = 0.005) and left ventricular dimensions - 0.499 (p = 0.024) and 0.485 (p = 0.030). Conclusions: ANP decreases significantly after pacing implementation in patients selected for implantation of VVI and DDD/VDD pacemakers. ANP correlates significantly with echocardiographic measurements in patients selected for DDD/VDD pacemakers, but no significant correlation is observed in VVI patients qualifying for permanent pacemaker due to atrioventricular block
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