Comparison of shortened gated myocardial perfusion imaging processed with „Myovation Evolution” with full time study

Background: The work compares results of shortened gated myocardial perfusion imaging (MPI), processed with „Myovation Evolution” software, with a study performed in a standard way.Material and methods: A retrospective study was conducted in a group of 95 patients (56 males and 39 females, age 62±9 years, BMI 28±4) with known or suspected CAD, without clinical history or any signs of a previous myocardial infarction. All patients underwent coronary angiography (CA) within 3 months of MPI. CA was used as a reference for diagnostic performance of MPI. Patients underwent a stress/rest 2-day MPI. Both studies were performed twice, with normal (25s) and shortened (13s) time per projection. Studies were processed using Myovation protocol (OSEM with 2 iterations and 10 subsets) for full time (FT) studies and a Myovation Evolution protocol dedicated to half time (HT) studies (OSEM with 12 iterations, 10 subsets). Reconstructed images, with and without attenuation correction (AC), were evaluated by 2 experienced nuclear medicine specialists (a consensus), with regard to image quality and perfusion, evaluated using a visual semi-quantitative method, applying a standard division of myocardium into 17 segments. Perfusion was assessed in every segment using a standard 5 grade scale. Summed stress scores were calculated for every patient and threshold values for detection of CAD were selected based on ROC analysis with CA treated as a reference method. After at least 2 months FT images were interpreted again by the same specialists.Results: Quality of images obtained from shortened and normal studies was equally good. All correlation coefficients between segmental scorings of FT and HT studies were high and statistically significant. Correlation coefficients between corresponding segments in FTAC and HTAC (i.e. with AC) studies were systematically higher than without AC. Agreement between FT and HT study results was equal to 81% for FT and HT studies and to 86% for FTAC and HTAC studies (p=0.40). Repeatability of FTAC study assessments was equal to 94%. 95-per cent confidence intervals calculated for agreement between FTAC and HTAC studies and repeatability of FTAC study overlapped considerably. Correlation coefficients for EDV, ESV and EF values between FT and HT were high: 0.93, 0.96 and 0.88, respectively. Conclusion: Myovation Evolution protocol used for reconstruction of myocardial perfusion studies with reduced number of counts requires AC. Disagreements observed during visual assessment of normal and reduced count studies are statistically not significantly larger than between dual assessment of a full count study.BACKGROUND: The work compares the results of shortened gated myocardial perfusion imaging (MPI), processed with „Myovation Evolution” software, with a study performed in a standard way. MATERIAL AND METHODS: A retrospective study was conducted in a group of 95 patients (56 males and 39 females, age 62 ± 9 years, BMI 28 ± 4) with known or suspected CAD, without clinical history or any signs of a previous myocardial infarction. All patients underwent coronary angiography (CA) within 3 months of MPI. CA was used as a reference for diagnostic performance of MPI. Patients underwent a stress/rest 2-day MPI. Both studies were performed twice, with normal (25s) and shortened (13s) time per projection. Studies were processed using Myovation protocol (OSEM with 2 iterations and 10 subsets) for full time (FT) studies and a Myovation Evolution protocol dedicated to half time (HT) studies (OSEM with 12 iterations, 10 subsets). Reconstructed images, with and without attenuation correction (AC), were evaluated by 2 experienced nuclear medicine specialists (a consensus), with regard to image quality and perfusion, evaluated using a visual semi-quantitative method, applying a standard division of myocardium into 17 segments. Perfusion was assessed in every segment using a standard 5 grade scale. Summed stress scores were calculated for every patient and threshold values for detection of CAD were selected based on ROC analysis with CA treated as a reference method. After 2 months FT images were interpreted again by the same specialists. RESULTS: The quality of images obtained from shortened and normal studies was equally good. All correlation coefficients between segmental scorings of FT and HT studies were high and statistically significant. Correlation coefficients between corresponding segments in FTAC and HTAC (i.e. with AC) studies were systematically higher than without AC. The agreement between FT and HT study results was equal to 81% for FT and HT studies and to 86% for FTAC and HTAC studies (p = 0.40). The repeatability of FTAC study assessments was equal to 94%. 95-percent confidence intervals calculated for agreement between FTAC and HTAC studies and the repeatability of FTAC study overlapped considerably. Correlation coefficients for EDV, ESV and EF values between FT and HT were high: 0.93, 0.96 and 0.88, respectively. CONCLUSION: Myovation Evolution protocol used for reconstruction of myocardial perfusion studies with reduced number of counts requires AC. The agreement between the results of visual assessment of normal and reduced count studies is high and not worse than the agreement between repeat assessment of a full time study

Reduced-time myocardial perfusion study processed with “Myovation Evolution” — assessment of diagnostic efficacy

BACKGROUND: While assessing images using standard segmental method, we felt that some defects were either underscored or missed. So this work is intended to compare results of low count myocardial perfusion studies (MPS) processed with „Myovation Evolution”, applying complete evaluation of all available slices, with full count studies and assess impact of reduction of counts on diagnostic efficacy of the study. MATERIAL AND METHODS: A retrospective study was conducted in a group of 95 patients (56 males, age 62 ± 9 years, BMI 28 ± 4) with known or suspected CAD, without clinical history or any signs of a previous myocardial infarction. All patients underwent coronary angiography (CA) within 3 months of MPS. CA was used as a reference method for diagnostic performance of MPS. Patients underwent a stress/rest 2-day MPS. Both studies were performed twice, with normal (25 s) and shortened (13 s) time/projection. Studies were processed using Myovation protocol (OSEM, 2 iterations, 10 subsets) for full time (FT) studies and a Myovation Evolution protocol for half time (HT) studies (OSEM, 12 iterations, 10 subsets, Resolution Recovery). Reconstructed images, with and without attenuation correction (AC), were evaluated by 2 experienced nuclear medicine specialists (a consensus) visually, taking into account all available slices, in a 5-grade scale (normal, probably normal, equivocal, probably abnormal and abnormal). Study results were additionally dichotomized as normal or abnormal. Perfusion defects were assigned to coronary arteries. RESULTS: An exact agreement between FT and HT study assessment, without AC, amounted to 66%, with AC it grew to 79%, p = 0.05. In studies without AC 10 perfusion defects were found only in HT studies in RCA area in male patients. A higher percentage of studies with perfusion defects in RCA area visible only in HT studies was found among discordant (7/25, 28%) than concordant results (3/70, 4%), p = 0.003. AC reduced this difference. HT study provided lower accuracy in detection of CAD than FT study (58% vs. 68%, p = 0.034). AC reduced this difference considerably. Dichotomized assessment agreed in 81% of studies without AC and in 87% with AC. CONCLUSIONS: Myovation Evolution protocol requires application of AC otherwise perfusion defects in RCA area in male patients are falsely detected. Shortened studies reconstructed with „Myovation Evolution” package without AC reveal a tendency toward reduction of accuracy of the study in detection of CAD. AC makes up for this reduction

The effect of image translation table on diagnostic efficacy of myocardial perfusion SPECT studies

BACKGROUND: The aim of this study was to determine which of the most popular colour scales used in the Xeleris processing system (GE) should preferably be used during a clinical interpretation of myocardial perfusion images, and to find out whether a colour scale saturation level affects the diagnostic efficacy of the study. MATERIAL AND METHODS: From among 100 patients in whom a myocardial perfusion scintigraphy had been performed, a subgroup of people referred for coronary angiography, with neither prior history nor ECG signs of a myocardial infarction has been selected retrospectively. This group consisted of 41 patients (14 females) in the age group 46 to 76 years. All patients underwent two-day myocardial perfusion SPECT imaging using 99mTc-MIBI as a radiopharmaceutical. Reconstructed slices were interpreted in 3 colour scales: white-red-yellow-green-blue-black with computer-assigned thresholds (French 100%), the same French scale but without a white colour (image maximum set manually to a border value between red and white &#8212; French w.w.), and a white-yellow-violet- pink-blue-black scale (GEcolor), by consensus of two experienced nuclear medicine specialists. A semiquantitative method for evaluation of perfusion images was applied, based on myocardium segmentation. Perfusion in each segment was scored using a five-point system. Study interpretation (normal/ abnormal perfusion) was based on summed stress scores (SSS), being equal/above or below a given threshold value. The choice of optimal SSS threshold value was based on sensitivity and specificity of the study in detection of perfusion defects resulting from critical stenoses of main coronary arteries RESULTS: SSS values differed among colour scales (p < 0.00001). The lowest values were obtained for a French 100% scale (mean value = 5.0, SD = 8.0), the highest for French w.w. (mean values = 8.1, SD = 8.7), and for GE colour scale &#8212; mean value &#8212; 5.6, SD &#8212; 7.9. A French 100% scale gave high sensitivity (88%), as well as specificity (83%), but only when a low SSS threshold value of 2, hardly acceptable for study interpreters, was used. When higher threshold values were applied, they compromised the sensitivity of the study. A French w.w. scale with SSS threshold values lower than 3 provided a slightly higher sensitivity (94%), but with a significant reduction in specificity (to values below 50%). Only a threshold value of 4 provided acceptable, but still low specificity (63%) with preserved high sensitivity (88%). At the same time, the scale GE colour provided indices of diagnostic efficacy with the SSS threshold value of 3 as high as a scale French 100% with threshold value of 2. CONCLUSIONS: A French scale (Xeleris, GE) is not the scale of choice for the interpretation of myocardial perfusion SPECT images. It seems that a GE colour scale is better suited for this purpose. SSS threshold values accepted as diagnostic criteria for the detection of myocardial perfusion abnormalities should be suited separately for every translation table. The choice of optimal value should be verified by results of coronary angiography. Nuclear Med Rev 2010; 13, 2: 64&#8211;6

Occupationally related cardiovascular diseases — significant health problem among employees

Choroby układu krążenia (CVD) są jedną z najważniejszych przyczyn zachorowań i umieralności w populacji polskiej i europejskiej, stanowiąc blisko połowę przyczyn zgonów. Dane epidemiologiczne dotyczące rozpowszechnienia CVD dowodzą ich istotnej roli w kształtowaniu sytuacji zdrowotnej ludności, w tym osób w wieku produkcyjnym, aktywnych zawodowo. W środowisku pracy może wystąpić narażenie na wiele czynników ryzyka CVD, zarówno klasycznych, jak i typowo zawodowych. Dodatkowo choroby te mogą stanowić ograniczenie lub przeciwwskazanie do podjęcia i/lub kontynuowania wykonywania zawodu. Szerokie rozpowszechnienie CVD, także w populacji osób młodych, oraz możliwość modyfikacji znanych czynników ryzyka, w tym również tych występujących na stanowisku pracy nakazuje poszukiwanie sposobów profilaktyki i wczesnego wykrywania CVD, aby zminimalizować ich negatywne skutki medyczne i społeczno-ekonomiczne zarówno w odniesieniu do jednostki, jak i ogółu populacji. Celem pracy była prezentacja związku najistotniejszych z punktu widzenia epidemiologii CVD z pracą zawodową, a także wykazanie istotnej roli poradnictwa zawodowego i opieki profilaktycznej oraz ich wpływu na kształtowanie ryzyka sercowo-naczyniowego wśród osób pracujących.Cardiovascular diseases (CVD) are a major cause of morbidity and mortality in the population of Poland and Europe. They constitute nearly half of the total causes of death. Epidemiological data on the prevalence of cardiovascular diseases have shown their crucial role in modifying the health situation of the population, including people in the working age. Work environment may modify or entail an exposure to a number of classic and professional cardiovascular risk factors. In addition, cardiovascular diseases may be a limitation or contraindication to take and/or to continue the occupation. High prevalence of CVD, including the young population and the ability to modify the known risk factors, including those occurring in the workplace, requires the searchfor the possibilities of prevention and early detection of CVD in order to minimize their negative effects on medical and socio-economical level, both in terms of to the individual patient and the general population. The aim of the study was to present the relationship between the most important cardiovascular diseases and occupation, as well as to demonstrate the important role of the preventive care and its impact on the cardiovascular risk

Effect of CT misalignment on attenuation — corrected myocardial perfusion SPECT

BACKGROUND: Use of CT based attenuation correction (AC) for myocardial perfusion SPECT (MPS) is growing fast due to a rapid development of hybrid SPECT/CT systems. SPECT and CT studies are performed in a sequential way extending total study acquisition and making a patient movement more likely. The present work aims at answering the question how large misalignment between SPECT and CT studies should be considered significant and how often those misregistrations are observed. MATERIAL AND METHODS: A retrospective study applying AC was performed in 107 patients who had coronary angiography (CA) performed within 3 months. Patients underwent a stress/rest Tc-99m MIBI 2 day SPECT/CT myocardial perfusion study. In case of SPECT and CT misalignment CT slices were shifted manually; shifts along 3 axes were recorded and after realignment a repeat reconstruction was performed. Euclidean distance of misalignment was also calculated. Images were analyzed by two experienced nuclear medicine specialists (consensus) applying visual semiquantitative method. Perfusion of three arteries was scored using a 5 grade scale. CA results were used as a reference for MPS findings. RESULTS: In 47 patients (44%) CT realignment was necessary. CT was shifted mostly along x and y axes, and less often along z axis. Euclidean distance S exceeded 2 pixels in 3 stress and 2 rest studies. Only in 7 patients changes of scores assigned to coronary vessels were noted as a result of CT realignment. These changes concerned 9 vessel areas. In 7 out of 9 cases changes were noted toward a better agreement with results of CA. Only in one patient, with stress S &gt; 3 pixels and negative result of CA, CT realignment changed vessel area score significantly, from probably abnormal to normal. CONCLUSIONS: Only misalignments large enough, exceeding 2–3 pixels, have negative impact on attenuation corrected images. Such misalignments are rare, in our material were observed in 3 stress and 2 rest studies (3% and 2% of all studies, respectively). Only in one patient (below 1% of all studied patients) CT misalignment caused a significant study misinterpretation. Although alignment of SPECT and CT studies should be checked in every patient, small misalignments do not affect study interpretation

Self-expanding STENTYS stents in daily routine use

Wstęp: Zabieg angioplastyki naczyń wieńcowych (PCI) jest uznaną metodą leczenia choroby wieńcowej. Jednak u niektórych pacjentów ze złożoną morfologią naczyń wieńcowych jest niezmiernie trudno oszacować referencyjną średnicę naczynia. Dlatego też wydaje się, że użycie stentów samorozprężalnych, które adaptują się do średnicy naczynia, może być korzystne. Cel: Celem pracy była ocena zabiegów PCI wykonanych z wykorzystaniem stentu samorozprężalnego STENTYS®. Metody i Wyniki: Grupę badaną stanowiło 40 pacjentów z chorobą wieńcową stabilną i z różnymi postaciami ostrych zespołów wieńcowych (ACS), u których implantowano stent STENTYS®. Stent wszczepiono wszystkim pacjentom. W trakcie obserwacji krótkoterminowej 2 osoby zmarły zaraz po wykonaniu PCI — byli to chorzy z krytycznym zwężeniem pnia lewej tętnicy wieńcowej, we wstrząsie kardiogennym i zdyskwalifikowani z zabiegu pomostowania aortalno-wieńcowego. Ponadto u jednego z pozostałych pacjentów rozpoznano zawał serca typu 4b, a u dwóch chorych w trakcie implantacji wystąpiła dysekcja naczynia wymagająca założenia kolejnego stentu. Pomimo opisywanych powikłań u wszystkich chorych z badanej grupy stent został zaimplantowany w miejscu wybranym przez operatora. W trakcie długoterminowej obserwacji zanotowano konieczność ponownej rewaskularyzacji u 3 (7,8%) pacjentów w stentach STENTYS BMS. Nie wystąpiła restenoza w stentach STENTYS DES, nie zaobserwowano zakrzepicy w stentach DES/BMS. Wnioski: Stent samorozprężalny STENTYS® umożliwia wykonywanie zabiegów angioplastyki u pacjentów ze złożoną morfologią zmian miażdżycowych. Charakteryzuje się niskim odsetkiem konieczności powtórnej rewaskularyzacji i dobrymi wynikami odległymi.  Background: In the era of modern interventional cardiology, implantation of a balloon expandable stent is the finishing touch of almost every coronary angioplasty. However, sometimes we face a clinical situation in which the decision regarding the stent diameter is complicated, especially in the ectatic part of arteries, in situations when the artery lumen is obscured with the thrombus, or when the reference diameter of the proximal and distal part of the lesion vary greatly. That is why the idea of a self-apposing stent similar to the one used in peripheral vascular interventions was adopted into cardiology. Aim: The aim of this study was to present a single-centre registry of STENTYS® stent implantation in 40 selected patients with acute coronary syndromes (ACS) or with stable angina (coronary artery disease [CAD]) treated with this self-expandable stent. Methods and Results: The device was successfully implanted in all patients. During in-hospital observation and 30-day follow-up there were two cases of death, but none of the patients had acute stent thrombosis or ACS ST elevation myocardial infarction. In one case ACS type 4b was diagnosed. In all patients the stent was delivered in the target lesion. In two cases the procedure was performed in patients with multivessel CAD extending into the left main stem in a state of cardiogenic shock. These patients died immediately after the procedure. There were two procedure complications: in one case dissection after post dilatation occurred distally to the stent, and in one patient the calcified proximal part of the left anterior descending artery was dissected with system passage. Thirty-eight patients survived the 12-month follow-up period, and three (7.8%) patients underwent repeated target-lesion revascularisation. Conclusions: In the presented single-centre registry the STENTYS® stent was used with a high delivery and procedural success rate. Satisfactory clinical long-term outcome both in stable patients and ACS patients with a repeated revascularisation ratio of 7.8% was observed. The stent design allowed successful treatment of bifurcation lesions.

Genetic determinants of haemostasis in cardiovascular diseases the role of gene promotor regions

In this review the potential role of polymorphism gene promoter regions of beta-chain fibrinogen and plasminogen activator inhibitor type I (PAI-1) in cardiovascular disease is discussed. The thorough discussion covers the potential mechanisms of their effect.Zadanie pt. „Digitalizacja i udostępnienie w Cyfrowym Repozytorium Uniwersytetu Łódzkiego kolekcji czasopism naukowych wydawanych przez Uniwersytet Łódzki” nr 885/P-DUN/2014 dofinansowane zostało ze środków MNiSW w ramach działalności upowszechniającej naukę

Dietary intake of omega fatty acids and polyphenols and its relationship with the levels of inflammatory markers in men with chronic coronary syndrome after percutaneous coronary intervention

Background: The platelet‑to‑lymphocyte ratio (PLR), neutrophil‑to‑lymphocyte ratio (NLR), and C‑reactive protein (CRP) are useful in assessing inflammation in patients after percutaneous coronary intervention (PCI). The PLR and NLR are also independent predictors of cardiovascular mortality. Moreover, higher CRP levels increase the risk of long‑term mortality in patients undergoing PCI. Aims: We aimed to investigate the relationship between the dietary intake of omega‑3 and omega‑6 fatty acids and plant polyphenols and the levels of inflammatory markers in patients after PCI. Methods:  In this retrospective study, we used the validated Food Frequency Questionnaire and Aliant software to estimate the dietary intake of polyphenols and omega‑3 fatty acids as well as the ratio of omega‑6 to omega‑3 fatty acids in patients after PCI. A total of 105 patients were divided into subgroups based on high or low dietary polyphenol intake, omega‑3 fatty acid intake, and omega‑6 / omega‑3 fatty acid ratio. Data on complete blood count were obtained from the hospital laboratory. Results: In this retrospective study, we used the validated Food Frequency Questionnaire and Aliant software to estimate the dietary intake of polyphenols and omega‑3 fatty acids as well as the ratio of omega‑6 to omega‑3 fatty acids in patients after PCI. A total of 105 patients were divided into subgroups based on high or low dietary polyphenol intake, omega‑3 fatty acid intake, and omega‑6 / omega‑3 fatty acid ratio. Data on complete blood count were obtained from the hospital laboratory. Conclusions: Anti‑inflammatory effects of a diet should be assessed not only based on a high intake of omega‑3 fatty acids but also balanced omega‑6 / omega‑3 ratio, which reduces PLR and CRP levels in patients with cardiovascular disease

Zabiegi angioplastyki naczyń wieńcowych u pacjentów w wieku ponad 85 lat: ocena powikłań i śmiertelności wewnątrzszpitalnej

Wstęp: W ostatnich latach obserwuje się systematyczny wzrost liczby pacjentów w wieku podeszłym kierowanych na zabiegi przezskórnej interwencji wieńcowej (PCI). Mimo to wielu kardiologów interwencyjnych niechętnie kwalifikuje te osoby do PCI ze względu na niepewne wyniki tych procedur u pacjentów w bardzo podeszłym wieku, tzw. chorych długowiecznych, starszych niż 85 lat. Cel: Celem niniejszego badania była ocena parametrów demograficznych, klinicznych i angiograficznych, a także wyników zabiegów PCI u pacjentów w wieku &gt; 85 lat, w porównaniu z młodszymi chorymi hospitalizowanymi w 2012 r. Metody: Przeprowadzono jednoośrodkowe, retrospektywne badanie obejmujące grupę 920 kolejnych osób poddanych PCI. Byli to pacjenci z rozpoznaną chorobą wieńcową, zarówno stabilną, jak i z ostrymi zespołami wieńcowymi (ACS). Pacjentów podzielono na dwie grupy względem wieku: grupę GER — osoby w wieku ≥ 85 lat (n = 82) i grupa kontrolna (GK) w wieku &lt; 85 lat (n = 838). Wyniki: Średni wiek w grupach badanych wynosił 88,6 roku (GER) vs. 66,7 roku (GK). Wśród chorych starszych było istotnie więcej kobiet (57% vs. 29%; p &lt; 0,001). W grupie GER wskazaniem do PCI był głównie ACS (65% vs. 50%), w tym zawał z uniesieniem odcinka ST (30% vs. 29%; p = NS), a ACS bez uniesienia odcinka ST rozpoznano u 35% w grupie GER vs. u 20% w grupie GK (p = 0,01). Pacjenci z grupy GER charakteryzowali się większą liczbą chorób współistniejących, a także bardziej zaawansowaną postacią choroby wieńcowej ze zmianami w trzech naczyniach wieńcowych. Odsetek osób poddanych PCI, u których stwierdzono powikłania (zgon, ponowny zawał serca, udar, krwawienie) był istotnie wyższy w grupie GER niż w grupie kontrolnej. Wewnątrzszpitalna śmiertelność była istotnie wyższa wśród chorych starszych (4,8%) w porównaniu z grupą kontrolną (0,83%), jednak należy zaznaczyć, że zgony obserwowano tylko i wyłącznie u pacjentów poddanych PCI z rozpoznaniem ACS. Najczęstszym powikłaniem w grupie GER była nefropatia wywołana kontrastem (18,2% vs. 6,2%). Ciężkie powikłania zagrażające życiu, a także śmiertelność były istotnie wyższe w grupie chorych w podeszłym wieku hospitalizowanych z powodu ACS. Wnioski: Pacjenci w wieku &gt; 85 lat poddawani PCI są narażeni na większe ryzyko wystąpienia powikłań w trakcie hospitalizacji, szczególnie nefropatii wywołanej kontrastem. W grupie chorych w podeszłym wieku śmiertelność okołozabiegowa była istotnie wyższa, jednak tylko wśród pacjentów z ACS.  Background: There is systematic growth in the number of number of elderly patients treated with percutaneous coronary intervention (PCI); however, little is known about PCI results in the very elderly (long-lived) patients aged 85 years and above. Aim: To assess the demographic, clinical, and angiographic findings in patients aged &gt; 85 years (GER), undergoing PCI, compared with younger patients treated in the year 2012. Methods: This was a single centre retrospective study based on a consecutive group of 920 patients with coronary disease (stable and acute coronary syndrome [ACS]). Patients were divided into two groups: GER aged 85 years and over (n = 82) and controls (CG) below 85 years (n = 838). Results: The mean age in the GER group was 88.6 vs. 66.7 years in the CG. There were more females in the GER group (57% vs. 29%) than in the CG (p &lt; 0.001). The indication for PCI was mainly ACS in GER (65%) vs. CG (50%) including ST segment elevation myocardial infarction (STEMI) 30% vs. 29% (p = NS), ACS non-STEMI 35% vs. 20% (p = 0.01). GER patients had more comorbidities and more advanced multivessel coronary artery disease. The ratio of procedural success was lower in GER compared to CG. The incidence of in-hospital death was higher in GER (4.8%) compared to CG (0.83%); the most common complication in GER group was contrast-induced nephropathy (18.2% vs. 6.2%). Major adverse cardiovascular events were significantly more frequent in GER patients with ACS compared to CG patients with the same diagnosis. Conclusions: Patients &gt; 85 years old, especially with ACS undergoing PCI, are at greater risk of in-hospital complications, especially contrast-induced nephropathy and procedural complications, compared to younger patients.

Rare cardiovascular diseases in the context of occupational health care

In Poland like in other European countries a favorable trend towards reducing morbidity and mortality from cardiovascular disease has been observed. Nevertheless they are still one of the most important health problems in the population, responsible for nearly half of all deaths, including premature deaths. They also affect the quality of life in terms of health and socio-economic development, limiting the possibility of taking and/or continuing employment. Nowadays, cardiovascular diseases have become more common among young, professionally active people. Their professional activity, work organization and exposure to a broad range of occupational factors and environmental conditions may significantly influence the development and course of the cardiovascular disease. The aim of the study was to present the relationship between occupation and some rarer diseases and cardiovascular pathologies, as well as those in which this relationship has not as yet been fully evidenced, however, they may play an important role in workers’ health care. In this paper tako-tsubo cardiomyopathy, aortic aneurysm, aortic dissection, pericardial tamponade, Brugada syndrome and sudden cardiac death are discussed. In addition, the authors indicate new issues emerging along with the development of modern diagnostic and therapeutic techniques in cardiology, such as the care of patients with implanted pace-maker and the use of automated external defibrillators. These issues are presented in the context of their relationship with the occupation, taking into account the activities possibly to be undertaken under preventive care programs. Med Pr 2014;65(6):847–85