QT DISPERSION AND DIPYRIDAMOLE-INDUCED MYOCARDIAL ISCHEMIA

The relationship between QT interval dispersion and dipyridamole-induced, transient myocardial ischemia was assessed in 32 male patients with ischemic heart disease. A standardized, high dose dipyridamole-ECG stress test was used as dipyridamole infusion of 0,56 mg/kg applied i. v. for 4 min followed by 4 min interval of no-dose with E C G and blood pressure monitoring, and in negative test - by a dipyridamole infusion of 0,28mg/kg i. v. for 2 min. Seventeen patients (53%) developed a transient myocardial ischemia with duration of 20 ±7 (4-40) min during the dipyridamole infusion while 15 ones (47%) did not. No regular dynamics and significant differences in the values of total QT interval dispersion and maximum adjacent QT interval dispersion estimated before, during and after the dipyridamole infusion could be established. It was supposed that the severity, duration and time for development of dipyridamole-induced transient myocardial ischemia were not sufficient to generate a dispersion in ventricular repolarization detectable as changes in QT dispersion parameters on surface ECG. The combination of QT dispersion with various non-invasive markers of arrhythmogenic mechanisms could help the estimation of arrhythmogenic risk in the patients with ischemic heart disease

Carbopol hydrogel/sorbitan monostearate-almond oil based organogel biphasic formulations: Preparation and characterization of the bigels

Purpose: To obtain and evaluate carbopol hydrogel/sorbitan monostearate-almond oil-based organogel biphasic formulations (bigels) as a semi-solid vehicle for medicated topical applications.Methods: Bigel formulations were obtained under mild conditions at a hydrogel/organogel ratio of 80/20, 70/30, and 60/40 (w/w). Their stability, viscosity, spreadability, microarchitecture, and acute skin toxicity were evaluated.Results: Two formulations, prepared at ratios of 80/20 and 70/30, were stable based on intermediate stability testing, and had a similar viscosity and spreadability (38.0 ± 1.0 mm and 37.3 ± 0.6 mm, p > 0.05, respectively). Both of these formulations had a bimodal droplet size distribution and very similar values for the droplet mean diameter (0.33 ± 0.05 μm and 2.35 ± 0.44; and 0.34 ± 0.04 μm and 2.59 ± 0.21 μm). The formulation obtained at a ratio of 60/40 was unstable during storage. The in vivo results did not reveal any signs of skin toxicity.Conclusion: Considering their beneficial properties, the developed bigels are a potential semi-solid vehicle for topical application and exhibit a moisturizing effect.Keywords: Almond oil, Bigels, Carbopol hydrogel, Moisturizing effect, Organogel, Sorbitan monostearat

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Primary malignant tumors of the heart - surgical treatment and experience of the Department of Cardiac Surgery `Sveta Marina` University Hospital Varna

Primary cardiac tumors are rare with an incidence of 0.0017 to 0.0019%. Approximately 25% of these tumors are malignant, represented primarily by sarcomas. Most common types of sarcoma are leyomiosarcoma and angiosarcoma. Other histhologic subtypes of sarcoma are considerably less common. Since 2008 we have diagnosed and treated two cases of malignant heart tumors in our intitution. Both tumors were of extremely rare morphologic subtype - liposarcoma and malignant histiocytoma. To our knowledge there are 18 cases of primary liposarcoma of the left ventricle and 20 cases of malignant histiocytoma described in specialized literature up to current date.We present both our cases of primary malignant heart tumors with diagnostic, surgical and postoperative details including long term follow-up.Key words: liposarcoma, histiocytoma, malignant, surgical treatmen

Adults with congenital heart diseases: our experience with diagnosis and surgical treatment

Introduction: The population of adults with congenital heart disease (CHD) (commonly called grown-ups with congenital heart disease or GUCH) is increasing steadily, due to the remarkable improvement in survival of patients with CHD. In addition, some defects (e.g. ASD, CoA, Ebstein`s anomaly, and ccTGA) may be diagnosed for the first time in adult life. In Europe (727 million inhabitants), the GUCH population is estimated between 1.2 and 2.7 million patients with prevalence of about 2800 adults per 1 million. In Bulgaria, there isn`t confirmed statistical analysis, but the data from different health centers suggest of about 20 000 cases. Methods: We made an overview of echocardiographic and surgical approach to GUCH patients operated on at the Department of Cardiac Surgery in St.Marina University Hospital, presenting examples of the most interesting abnormalities observed. The surgical approach classifies them in 2 groups: (1) survival into adulthood of patients with known congenital heart disease and previous surgical procedures (2) patients with conditions not diagnosed or not considered severe enough to require surgery in childhood. The echocardiographic approach divides them in several categories: (1) stenotic lesions (2) regurgitant lesions (3) intracardiac shunts (4) abnormal connections (5) combinations or complex congenital diseases.Aim: Our aim is to compare the prevalence of adult congenital heart disease in our department with European data.Results and conclusion: No significant difference was found in the rate and approach between our practice and reported European sources. Key words: adult congenital heart diseases, prevalence, diagnosis, echocardiography, surgical treatmen

Surgical remodelling of the left ventricle - theory and practice in the Department of Cardiac Surgery in `Sveta Marina` University Hospital, Varna, Bulgaria

Early and aggressive treatment of acute myocardial infarction (MI) results in a decrease of the incidence of late complications. Nowadays the evolution of about 7.6% of all cases of transmural MI of the left ventricle (LV) results in aneurysm formation. The aneurysm itself as well as other consequences of the myocardial loss is related to impaired systolic and diastolic LV function, risk of rupture of the LV wall or potentially embologenous thrombosis in the LV cavity.These characteristics contribute to a constant trend towards timely and contemporary surgical treatment of this category of patients in terms of operative strategy and technique. It also stimulates the conduction of large and powerful trials in this field and the creation of databases including the early, midterm and late outcomes that further enhance the understanding of the most suitable treatment algorithm. Since the first surgical procedures in the 1950s the techniques have evolved offering an individualized approach as each procedure is distinguished for its surgical complexity and achieved results.Along with the descriptive characteristics of the evolution of surgical techniques for correction of LV aneurysms the current text also presents the experience of the Department of Cardiac Surgery in `Sveta Marina` University Hospital in Varna, Bulgaria with the surgical remodeling of the LV and the early results in this patients category. During the period 01.01.2008 - 31.12.2013 a total of 22 patients underwent myocardial revascularization and repair of LV aneurysm, 8 with linear repair and 14 with Dor procedure. 87.5% (7/8) of the patients with linear repair and 85.7% (12/14) of these with Dor procedure survived the early postoperative period and presented with significantly reduced postoperative volumes and improved function of the LV. Despite the small number of cases this proves both techniques ensure acceptable surgical results for these severely ill patients.Key words: left ventricular aneurysm, surgical remodelling of the left ventricl

Prevalence of comоrbidities in a cohort of patients with hemodynamically significant, pure aortic stenosis and sinus rhythm, admitted to cardiosurgery for a primary, isolated aortic valve replacement

Once judged a degenerative disease, aortic valve stenosis is now believed to be very similar in terms of pathogenesis to atherosclerosis. This initial plaque of aortic stenosis is alike that of coronary artery disease. Risk factors associated with coronary artery disease - including age, male sex, hyperlipidaemia, and evidence of active inflammation - are held in common by the two disorders. Over the past decade a new hypothesis was coined, that comorbidities such as overweight/obesity, diabetes mellitus, chronic obstructive pulmonary disease, and salt-sensitive hypertension induce a systemic proinflammatory state wich, in turn, favours hypertrophy development. The latter contributes to high diastolic left ventricular stiffness and heart failure development. Comorbidities, along with other important biological markers, are proposed to be included in diagnostic algorithms. It is expected that comorbidities may have an important impact on the prognosis after aortic valve remplacement in patients with calcific aortic valve stenosis. In the current paper, we analyse the comorbidity profile amont patients with hemodynamically significant, pure aortic stenosis and sinus rhythm, admitted to cardiosurgery clinic for primary, isolated aortic valve replacement.Key words: aortic valve stenosis, aortic valve replacement, comorbidit

Abstracts of the 20th annual meeting of the association `Heart - Lung` and 2nd „Varna - Augsburg` conference 30-31 may 2014

Primary tumours of the heart are rare. Metastases are the most frequent tumours of the heart. Anyway, it is generallyagreed that autopsy prevalence of primary cardiac tumors is 1 out of 2,000 and that of secondary cardiactumors is 1 out of 100 autopsies, with a secondary/primary cardiac tumors ratio of 20:1. Cardiac tumors may occurin any cardiac tissue. They can cause valvular or inflow-outflow tract obstruction, thromboembolism, arrhythmias,or pericardial disorders. Symptoms are very variable and can be the result of either local or systemiceffects. Surgery is successful for benign tumours when adequate resection margins are allowed. A number of imagingmodalities are available for the assessment of cardiac tumours; each has advantages and limitations. Thisreport presents our experience in the treatment of tumors of the hear