Sinoatrial Wenckebach periodicity as an independent marker for the development of high-degree sinoatrial exit block

Background: The present study of patients with Wenckebach-type second-degree sinoatrial block (W-block) evaluated the probability of the development of a more advanced grade of sinoatrial block. Data on the clinical significance of W-block are limited. It is unknown whether W-block predicts a more advanced grade of sinoatrial block. Methods: Standard ECGs of 412 patients with symptoms that might have been related to cardiac arrhythmias were reviewed for the presence of W-block. In the initial ECG W-block occurred in 29. During the follow-up period of 62 ± 35 months the main end-point was the first episode of type II second-degree sinoatrial block. An additional end-point was the occurrence of a sinus pause greater than 3 s or the development of type II second-degree sinoatrial block. Results: Of the 29 patients with W-block initially, 6 (20.7%) developed higher grade sinoatrial block, and sinoatrial arrhythmic events occurred in 9 (31%). In the 383 patients without W-block subsequent episodes of higher grade sinoatrial block occurred in 14 (3.7%) and sinoatrial arrhythmic events in 28 (7.3%). A multivariate Cox analysis identified W-block as an independent marker for developing type II second-degree sinoatrial block (HR = 3.72, 95% CI 1.39-9.99) and for the occurrence of sinoatrial arrhythmic events (HR 3.01, 95% CI 1.37-6.58). Conclusions: In patients with symptoms that might be caused by cardiac arrhythmias the presence of W-block in a standard ECG indicates a high probability of developing a more advanced grade of sinoatrial block. (Cardiol J 2007; 14: 391-395

Socioeconomic determinants of prostate-specific antigen testing and estimation of the prevalence of undiagnosed prostate cancer in an elderly Polish population based on the PolSenior study

Introduction: Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing. Material and methods: We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55-59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects. Results: The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06, p < 0.001), higher personal income (OR = 1.56, p < 0.001), better education (OR = 1.49, p = 0.001), previous white-collar work (OR = 1.37, p = 0.005), alcohol abstinence (OR = 1.28, p = 0.02), married status (OR = 1.24, p = 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65, p < 0.001), and dependence in ADL (OR = 0.55, p < 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65-74-year-old and 4.5% of 55–59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55-59 and 65-74 years, respectively. Conclusions: In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men

Early diagnosis of diastolic left ventricular dysfunction in patients with primary hypertension based on seismocardiography

Wstęp Zaburzenia funkcji rozkurczowej u chorych na nadciśnienie tętnicze (NT) są wczesnym objawem i wyprzedzają zaburzenia funkcji skurczowej oraz rozwój przerostu lewej komory serca. Celem pracy była ocena przydatności sejsmokardiografii (SKG) do wczesnego wykrywania zaburzeń funkcji rozkurczowej u chorych z NT. Materiał i metody Badaniami objęto 60 mężczyzn: 30 z NT pierwotnym łagodnym i umiarkowanym w wieku 37 &#177; 6 lat (grupa A) i 30 zdrowych ochotników w wieku 34 &#177; 7 lat (grupa B). U wszystkich badanych wykonano elektrokardiograficzną (EXT) i SKG próbę wysiłkową. Pacjenci z NT mieli wykonane badanie echokardiograficzne. Analizie poddano: z próby SKG - podokresy skurczu i rozkurczu lewej komory w spoczynku i bezpośrednio po wysiłku w ms: PEP, LVET, IVCT, IVRT, PEP/LVET, MPI i wartość g; z próby EXT - czas trwania (min), obciążenie (W), HR i RR w spoczynku i wysiłku; z badania ECHO: EF, E/A, DT, IVRT. Wyniki Na podstawie SKG pacjenci z NT prezentowali gorszą globalną funkcję mięśnia sercowego w postaci wyższego MPI: 0,36 &#177; 0,11 vs. 0,26 &#177; 0,1, p = 0,001 oraz niższej wartości g: 87 &#177; 29 vs. 106 &#177; 19, p < 0,01. Ponadto u chorych z NT stwierdzono pogorszenie funkcji RLK w czasie wysiłku (wydłużenie IVRT) w porównaniu z osobami zdrowymi (60 &#177; 18 ms vs. 38 &#177; 16 ms, p < 0,001). Wnioski U pacjentów z NT stwierdzono w czasie wysiłku istotnie gorszą globalną funkcję mięśnia sercowego ocenianą parametrem MPI w porównaniu z osobami zdrowymi. U pacjentów z NT w czasie wysiłku stwierdzono pogorszenie funkcji RLK ocenianej sejsmokardiograficznie. SKG może być użyteczną metodą wczesnego wykrywania zaburzeń funkcji RLK u chorych z NT. Nadciśnienie Tętnicze 2007, tom 11, nr 4, strony 304-309.Background In patients with hypertension diastolic dysfunction of left ventricle is early symptom and overtakes hypertrophy and systolic dysfunction. Seismocardiography (SCG) can be used for monitoring changes in cardiac function during exercise test (EXT) based on systolic and diastolic cardiac time intervals (CTI). The aim of the study was to assess the usefulness of SCG for early diagnosis of left ventricular diastolic dysfunction in patients with primary hypertension. Material and methods The study population consisted of 60 persons divided into two groups: A: 30 pts with essential hypertension, 37 &#177; 6 years with normal systolic and diastolic function; B: 30 healthy volunteers (HV), 34 &#177; 7 years. All of them had symptom-limited EXT on cycloergometer performed. SCG was done simultaneously with EXT. Workload in Watts, duration of EXT in minutes, HR and BP at rest and effort from EXT as well as CTI - PEP, IVCT, LVET, IVRT, PEP/LVET, MPI = (IVCT+IVRT)/LVET), g value, from SCG were measured. Results Worse global myocardial performance in the group of hypertension pts in range of higher MPI 0.36 &#177; 0.11 vs. 0.26 &#177; 0.1 (p = 0.001) as well as diastolic dysfunction in range of prolongation of IVRT during exercise (56 &#177; 12 - 60 &#177; 19 ms) were stated. Longer IVRT (60 &#177; 18 vs. 38 &#177; 16) (p < 0.001) and lower g value (87 &#177; 29 vs. 106 &#177; 19) (p < 0.01) during exercise in comparison to HV were stated. Conclusions Worse global myocardial performance in hypertension patients during exercise SCG in comparison with HV were stated. In hypertensive patients diastolic dysfunction during exercise SCG was revealed. Seismocardiography may be useful method for early diagnosis of left ventricular diastolic dysfunction. key words: seismocardiography, primary hypertension, diastolic dysfunction Arterial Hypertension 2007, vol. 11, no 4, pages 304-309

The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study)

Background: The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085). Methods: One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment. Results: Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of­fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect. Conclusions: Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease