Early and late changes in myocardial function and heart rate variability in patients after myocardial revascularisation

BACKGROUND: The purpose of the study was to evaluate the effect of myocardial revascularisation and associated improvement of left ventricular systolic function on heart rate variability in patients after myocardial infarction. MATERIAL AND METHODS: The study population consisted of 35 patients, who within the previous 6 months had suffered from myocardial infarction and in whom low dose dobutamine ventriculography revealed hibernating myocardium, whereas coronary angiography provided indications to revascularisation. CABG was performed in 22 patients, PTCA of the infarct-related artery in 13 patients. At baseline, 3 months and 3 years after the procedure radionuclide ventriculography, myocardial perfusion scintigraphy and 24hr continuous ECG recording were performed. RESULTS: After initial improvement of systolic function in ventriculography (EF = 48.63 ± 11.6 v. 52.37 ± 11.27 at p < 0.001) it slightly but not significantly decreased at long-term follow-up (EF = 51.8 ± 10.77). The remaining parameters of systolic function function behaved in a similar way in radionuclide ventriculography. Diastolic function parameters did not change significantly at early and long-term follow-up. HRV measures did not change at 3 months but at 3 years both sympathetic- and parasympathetic- related parameters and global autonomic activity were diminished. At 3 years global autonomic activity and parasympathetic activity were diminished with their values similar in both groups. CONCLUSIONS: It seems that HRV measures diminish at long- -term follow-up. The type of revascularisation procedure is only of short-range value with the parameters stabilising on a similar level at long-term follow-up

Variant Brugada syndrome : mild ST segment elevation in inferior leads and aborted sudden cardiac death

We describe a case of an otherwise healthy 48-year-old man who survived aborted sudden cardiac death (SCD). His ECG showed ST segment elevation in inferior leads, therefore an acute coronary syndrome was suspected. However, serial troponin T and CPK-MB were negative, echocardiogram was unremarkable and exercise test was negative. On the basis of electrophysiological study, positive ajmaline test, persistent ST segment elevation in inferior leads and other clinical features (PQ interval of 240 ms, family history of SCD) a diagnosis of variant Brugada syndrome was made. Persistent ST segment elevations in inferior leads can be a marker of variant Brugada syndrome

Practice setting and secondary prevention of coronary artery disease

Introduction: Patients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists. Material and methods: Five hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after hospitalization. The surveys were carried out in 1997-1998, 1999-2000, 2006-2007 and 2011-2013. Results: The proportion of smokers increased from 16.0% in 1997–1998 to 16.4% in 2011-2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% (p < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% (p = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% (p < 0.01), 47.7% and 52.8% (p = 0.53), 44.2% and 42.2% (p = 0.75) for high blood pressure, and 42.5% and 71.2% (p < 0.001), 51.4% and 79.6% (p < 0.001), 52.4% and 72.4% (p < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group. Conclusions: The control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs

Secondary prevention of coronary artery disease in contemporary clinical practice

Background: The highest priority in preventive cardiology was given to patients with estab-lished coronary artery disease (CAD). The aim of the study was to assess the implementation of guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates for patients, following their hospitalization for CAD. Methods: Five hospitals with cardiology departments serving the city and its surround-ing districts in southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalized from January 1 2010 to April 31 2012 due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after hospitalization. Results: The medical records of 595 patients (mean age: 62.8 ± 9.0 years, 397 men and 198 women) were reviewed and included in the analyses. Proportions of medical records with available information on risk factors were high with the exception of total cholesterol levels as well as weight and height measurements, which were available in less than 80 % of the hospita

Cardiac rehabilitation in real life

Participation in cardiac rehabilitation programs (CRPs) improves prognosis in patients with coronary artery disease (CAD). However, not much is known about the effectiveness of CRP in real life. The aim of this analysis was to identify factors related to the referral to CRP following hospitalization for CAD and estimate the effectiveness of the programs in real life. Medical records of 1061 consecutive patients aged ≤80 years, hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure in 5 hospitals serving the city and surrounding counties, were reviewed and 611 patients were interviewed 6–18 months posthospitalization. Of 611 patients participating in the interview, 212 (34.7%) were referred following the hospitalization to a center providing CRP. Age, hospitalization in a teaching hospital, and index diagnosis were independently related to being granted a referral. Among the referred patients, 86.3% participated in the CRP. Participation in CRP was related to the lower probability of having high total cholesterol (23% vs 32%, P < 0.05), fasting glucose (11% vs 18%, P = 0.05), Hb(A1c) (8% vs 16%, P = 0.05), and body mass index (27% vs 37%, P < 0.05). Generally, the effect of the CRP was significant in participants with a higher education, but not in those with a low education level. Other factors were not significantly related to the effectiveness of CRP. This study shows that CRPs are effective, but underused in Poland. The participant's education level may influence the effectiveness of CRP. Therefore, in order to increase the impact of CRP, the content of such programs should vary depending on the education level of the participants

Secondary prevention of coronary artery disease in contemporary clinical practice

Background: The highest priority in preventive cardiology was given to patients with estab­lished coronary artery disease (CAD). The aim of the study was to assess the implementation of guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates for patients, following their hospitalization for CAD. Methods: Five hospitals with cardiology departments serving the city and its surround­ing districts in southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalized from January 1 2010 to April 31 2012 due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after hospitalization. Results: The medical records of 595 patients (mean age: 62.8 ± 9.0 years, 397 men and 198 women) were reviewed and included in the analyses. Proportions of medical records with available information on risk factors were high with the exception of total cholesterol levels as well as weight and height measurements, which were available in less than 80% of the hospital records. The prescription rate at discharge for antiplatelets was 99%, beta-blockers (BB) — 85%, angiotensin converting enzyme inhibitors (ACEI) or sartans — 85%, and lipid-lowering drugs — 94%. Patients scheduled for coronary artery bypass grafting were significantly less often prescribed BB, ACEI or sartans, and lipid-lowering drugs. The proportion of patients with high blood pressure (≥ 140/90 mm Hg) 6–18 months after hospitalization was 47%, with high LDL cholesterol level (≥ 1.8 mmol/L) 73%, and with a high HbA1c level (≥ 7.0%) 14%, whereas 20% of participants were smokers and 80% were overweight. The proportion of patients taking an antiplatelet agent 6–18 months after hospitalization was 90%, BB — 82%, ACEI — or sartan 78%, and lipid-lowering drug — 82%. Overall, 33.9% of the study participants declared that they had been advised to participate in a rehabilitation/secondary prevention program following their hospitalization and 30.5% participated in a rehabilitation/secondary prevention program. However, only 28.2% took part in at least half of the planned sessions. Using a multivariate analysis we showed that, in general, risk factors control and the prescription rates of cardioprotective medications were related to the patients’ age, education, and participation in a rehabilitation/secondary prevention program following their hospitalization due to CAD. Conclusions: Our data provide evidence that there is a considerable potential for further reduction of cardiovascular risk in CAD patients. Our results suggest that increasing patient participation rates in rehabilitation/secondary prevention programs may improve the imple­mentation of the secondary prevention