Ūminio širdies nepakankamumo sąsajos su širdies ir kraujagyslių sistemos ligų baigtimis

Tyrimo tikslas. Nustatyti ūminių išeminių sindromų ir ūminio širdies nepakankamumo sąsajas su mirtimi nuo širdies ir kraujagyslių sistemos ligų stacionare bei mirtimi nuo širdies ir kraujagyslių sistemos ligų ir lėtiniu širdies nepakankamumu vienerių metų laikotarpiu. Tirtųjų kontingentas ir tyrimo metodika. Tirtųjų kontingentą sudarė nuoseklios imties 1554 ligoniai, susirgę ūminiais išeminiais sindromais (Q bangos miokardo infarktu – 607, miokardo infarktu be Q bangos – 441, nestabiliąja krūtinės angina – 500), 2005 m. gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (buvusiose Kauno medicinos universiteto klinikose) Kardiologijos klinikoje. Ligonių būklei stacionariniu laikotarpiu įvertinti naudoti Lietuvos sveikatos mokslų universiteto Širdies centro informacinės bazės duomenys. Ligonių būklė stebėta vienerius metus nuo hospitalizavimo dienos. Rezultatai. Ūminis širdies nepakankamumas stacionare diagnozuotas trečdaliui (32,3 proc.) ligonių, postacionariniu vienerių metų laikotarpiu lėtinis širdies nepakankamumas – beveik penktadaliui (17,0 proc.) ligonių. Miokardo revaskulizacija atlikta 70,8 proc. ligonių, kuriems vainikinių arterijų stenozė buvo ≥70 proc. Lėtinis širdies nepakankamumas po vienerių metų įvertintas 1039 ligoniams ir nustatytas tris kartus dažniau nei ligoniams be stacionare nustatyto ūminio širdies nepakankamumo (31,4 ir 11,6 proc., p<0,05). Mirtis nuo širdies ir kraujagyslių sistemos ligų stacionariniu ir postacionariniu laikotarpiu reikšmingai dažniau ištiko ligonius, kuriems buvo ūminis širdies nepakankamumas palyginti su ligoniais, kuriems nebuvo ūminio širdies nepakankamumo (11,5 ir 1,9 proc., p<0,001; 7,7 ir 2,3 proc., p<0,001). Išvada. Ištikus ūminiams išeminiams sindromams, atsiradęs ūminis širdies nepakankamumas reikšmingai didina lėtinio širdies nepakankamumo dažnumą postacionariniu vienerių metų laikotarpiu bei mirties nuo širdies ir kraujagyslių sistemos ligų dažnumą stacionare ir vienerių metų laikotarpiu

Admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus

The objective of this study was to determine frequency of admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus. Methods and results. Data on 1522 patients with acute myocardial infarction and no previous history of diabetes mellitus were analyzed. Before discharge from hospital, standardized oral glucose tolerance test was performed in 197 patients with admission hyperglycemia. Results. Admission hyperglycemia (≥6.1 mmol/L) was determined in half of the patients with acute myocardial infarction: glucose concentration of 6.1–6.99 mmol/L was in 21.5% and ≥7.0 mmol/L in 30.1% of the patients. By using glucose tolerance test, normal glucose metabolism was noted in 57.9% of the patients with admission hyperglycemia; abnormal glucose tolerance was diagnosed newly in more than one-third and glucose concentration of ≥11.1 mmol/L in 10.1% of the patients. Conclusions. Abnormal glucose tolerance is a frequent feature in nondiabetic patients with admission hyperglycemia during acute myocardial infarction, and glucose tolerance test should be considered in all patients with ischemic heart disease for early modification of this risk factor

Информативность смещения сегмента ST в остром периоде ИМ при выявлении риска летального исхода в течение 30 суток

In this paper was analyzed the informative value of the multidimensional variable – the dislocation of the ST segment from the isoelectric line for the prognostication of lethal outcome (LO) within 30 days with the help of multivariate logistic regression and determined the risk groups for LO within 30 days. The study included 462 patients who for the first time experienced acute myocardial infarction (MI).The patients were followed up for 30 days from the onset of MI, including hospital period. In our patients the elevation or depression of the ST segment from isoline in ECG registered within the first hours ranged from 0 to 9 mm. The multivariate model was developed using only those ST segment markers whose p values of likelihood ratio statistic in multidimensional logistic regression model did not exceed 0,2. The models were developed using the variable removal method, taking into consideration the strong correlation between some markers. In this study for clinical practice was introduced the ST informative score (STS). When using ST score, the patients were differentiated into ST score 3 risk groups: low, medium and high. In the high risk group (ST score > 25) lethal outcome occurred in 31 % of patients, in the low risk group (ST score ≤ 11) lethal outcome occurred in 1.9 % of cases (p < 0.0001)Kauno medicinos universiteto Kardiologijos institutasKauno medicinos universiteto Kardiologijos institutas, [email protected] Didžiojo universiteta

Prevalence of metabolic syndrome components in patients with acute coronary syndromes

Objective. Many studies report that the components of the metabolic syndrome – arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia – are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes. Methods and results. The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3±11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (≥6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components. Conclusion. More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome

Prognostication of late left ventricular systolic dysfunction in patients with acute coronary syndrome during the acute period

The aim of the study was to create the model of the combination of clinical and echocardiographic determinants during the acute period of acute coronary syndromes for the prognostication of the risk for left ventricular dysfunction after one year. We examined 565 patients with first-time acute coronary syndrome with no recurrence during one-year period. The studied group consisted of 496 patients, and the examined group – of 69 patients. All patients with acute coronary syndrome within the first three days underwent the evaluation of demographic, anamnesis, clinical indicators, risk factors for ischemic heart disease, ECG, and echocardiographic findings for the prognostication of the risk of left ventricular dysfunction after one year. Multiple logistic regression analysis was applied for the identification of independent determinants for the prognostication of left ventricular dysfunction, and three risk groups were identified. The prognostic informative value of the model was verified by comparing the incidence of left ventricular systolic dysfunction in risk groups after one year between the studied and the control groups. Results. After one year, left ventricular systolic dysfunction (left ventricular ejection fraction &lt;40%) in the presence of acute coronary syndrome remained in more than half (65.3%) of patients and returned to normal (left ventricular ejection fraction ³40%) in one-third of patients (34.7%). Left ventricular systolic function that was normal during the acute period of coronary syndrome remained such in the majority (80.9%) of patients after one year, whereas one-fifth (19.1%) of patients developed left ventricular systolic dysfunction. The mathematical model for the prognostication of systolic dysfunction after one year was composed of the determinants of acute coronary syndrome: left ventricular ejection fraction &lt;40%, anterior localization of Q-wave myocardial infarction, Killip class 3–4, left ventricular pseudo-normal or restrictive diastolic function, and frequent ventricular extrasystoles. The application of our model in the prognostication of late left ventricular systolic dysfunction during the acute period of coronary syndrome showed that the model was reliable, since after one year, the prognosticated left ventricular systolic dysfunction was determined in the majority (84.3%) of patients. The designed mathematical model is simple and is based on standard clinical and echocardiographic findings, and the scoring system allows for the prognostication of the risk for late left ventricular systolic dysfunction in any individual patient. The prognostication of the risk for late left ventricular systolic dysfunction during the acute period of coronary syndrome may help in the planning of treatment and outpatient care in patients with acute coronary syndrome

Cardiovascular risk in diabetes mellitus during one-year period after acute coronary syndrome

Aim. The significance of clinical characteristics during acute phase of coronary syndrome for hospital prognosis is well established. However their prognostic ability and impact on defining risk of lethal outcome during one-year period after acute coronary syndrome in pts with diabetes mellitus is not clarified. Methods. In a prospective one-year study 699 pts with first acute coronary syndrome were studied: 61 with diabetes mellitus and 638 – without diabetes mellitus. We have analyzed their demographic characteristics, risk factors of ischemic heart disease, clinical, echocardiographic, angiographic data. During one year follow up period there were 61 cases of cardiac death. Results. Univariate analysis showed, that pts with diabetes mellitus vs pts without diabetes mellitus more often were female, aged >65 years, had arterial hypertension, obesity and sinusal tachycardia, severe acute left ventricular failure, three – vessel coronary disease, episodes of paroxysmal atrial flutter during acute phase of acute coronary syndrome (p<0.05). Multivariate logistic regression analysis showed that these variables remained independent predictors for lethal outcome and had OR from 1.6 to 9.5 in pts without diabetes mellitus. The presence of diabetes mellitus increased the value of OR of these variables 1.5–2.5 fold and this followed to the further stratification of pts. The value ³14 of general risk score in multivariate model indicated the high risk for lethal outcome during one-year period. Almost half of pts (48.3%) with diabetes mellitus had the high risk, a 36.5 percent of them died during follow up. The sensitivity of risk score in predicting mortality was 37.3 percent in high risk group and 58.8 percent in low risk group, specificity – 96.7 percent and 82.7 percent respectively. Conclusion. [...]

Associations between acute heart failure and cardiovascular outcomes

Tyrimo tikslas. Nustatyti ūminių išeminių sindromų ir ūminio širdies nepakankamumo sąsajas su mirtimi nuo širdies ir kraujagyslių sistemos ligų stacionare bei mirtimi nuo širdies ir kraujagyslių sistemos ligų ir lėtiniu širdies nepakankamumu vienerių metų laikotarpiu. Tirtųjų kontingentas ir tyrimo metodika. Tirtųjų kontingentą sudarė nuoseklios imties 1554 ligoniai, susirgę ūminiais išeminiais sindromais (Q bangos miokardo infarktu – 607, miokardo infarktu be Q bangos – 441, nestabiliąja krūtinės angina – 500), 2005 m. gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (buvusiose Kauno medicinos universiteto klinikose) Kardiologijos klinikoje. Ligonių būklei stacionariniu laikotarpiu įvertinti naudoti Lietuvos sveikatos mokslų universiteto Širdies centro informacinės bazės duomenys. Ligonių būklė stebėta vienerius metus nuo hospitalizavimo dienos. Rezultatai. Ūminis širdies nepakankamumas stacionare diagnozuotas trečdaliui (32,3 proc.) ligonių, postacionariniu vienerių metų laikotarpiu lėtinis širdies nepakankamumas – beveik penktadaliui (17,0 proc.) ligonių. Miokardo revaskulizacija atlikta 70,8 proc. ligonių, kuriems vainikinių arterijų stenozė buvo ≥70 proc. Lėtinis širdies nepakankamumas po vienerių metų įvertintas 1039 ligoniams ir nustatytas tris kar­tus dažniau nei ligoniams be stacionare nustatyto ūminio širdies nepakankamumo (31,4 ir 11,6 proc., p<0,05). Mirtis nuo širdies ir kraujagyslių sistemos ligų stacionariniu ir postacionariniu laikotarpiu reikšmingai dažniau ištiko ligonius, kuriems buvo ūminis širdies nepakankamumas palyginti su ligoniais, kuriems nebuvo ūminio širdies nepakankamumo (11,5 ir 1,9 proc., p<0,001; 7,7 ir 2,3 proc., p<0,001). Išvada. Ištikus ūminiams išeminiams sindromams, atsiradęs ūminis širdies nepakankamumas reikšmingai didina lėtinio širdies nepakankamumo dažnumą [...]The aim of the study was to determine associations of acute coronary syndrome and acute heart failure with mortality from cardiovascular causes during hospitalization and mortality from cardiovas- cular causes and chronic heart failure during one-year period. Material and methods. A total of 1554 consecutive patients with discharge diagnosis of acute coronary syndrome, treated at the Clinic of Cardiology, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005, were prospectively enrolled into the study. For the assess- ment of patients’ status, data from the Cardiac Center Registry database were used. Patients were followed up for one year from admission to hospital. Results. Acute heart failure was diagnosed in 32.3% of patients during hospitalization, and chronic heart failure was diagnosed in 17% during a one-year follow-up period. Myocardial revascularization was perfor- med in 70.8% of patients with coronary artery stenosis of ≥70%. After one year, chronic heart failure was documented in 1039 patients, and it was almost three times more frequent in patients who had acute heart failure at diagnosis of acute coronary syndrome than in patients without acute coronary syndrome during hospitalization (31.4% vs. 11.6%; P<0.05). Death from cardiovascular causes occurred more frequently in patients with acute heart failure than without it during both in-hospital and out-of-hospital periods (11.5% vs. 1.9%, P<0.001; 7.7% vs. 2.3%, P<0.001). Conclusion. In the presence of acute coronary syndrome, diagnosed acute heart failure signifi cantly in- creases the frequency of chronic heart failure during one-year period and mortality rate from cardiovascular diseases during hospitalization and one-year periodLietuvos sveikatos mokslų universiteto Medicinos akademijos Kardiologijos instituta

Secondary prevention of ischemic heart disease: pharmacological treatment after myocardial infarction according to follow-up protocol

The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction. Material and methods. We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8±3.2 months after myocardial infarction were collected by letter with questionnaire. Results. Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely – two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Betaadrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6–10.3%). Conclusions. These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction

Prognostication of late left ventricular systolic dysfunction in patients with acute coronary syndrome during the acute period

The aim of the study was to create the model of the combination of clinical and echocardiographic determinants during the acute period of acute coronary syndromes for the prognostication of the risk for left ventricular dysfunction after one year. We examined 565 patients with first-time acute coronary syndrome with no recurrence during one-year period. The studied group consisted of 496 patients, and the examined group – of 69 patients. All patients with acute coronary syndrome within the first three days underwent the evaluation of demographic, anamnesis, clinical indicators, risk factors for ischemic heart disease, ECG, and echocardiographic findings for the prognostication of the risk of left ventricular dysfunction after one year. Multiple logistic regression analysis was applied for the identification of independent determinants for the prognostication of left ventricular dysfunction, and three risk groups were identified. The prognostic informative value of the model was verified by comparing the incidence of left ventricular systolic dysfunction in risk groups after one year between the studied and the control groups. Results. After one year, left ventricular systolic dysfunction (left ventricular ejection fraction <40%) in the presence of acute coronary syndrome remained in more than half (65.3%) of patients and returned to normal (left ventricular ejection fraction ³40%) in one-third of patients (34.7%). Left ventricular systolic function that was normal during the acute period of coronary syndrome remained such in the majority (80.9%) of patients after one year, whereas one-fifth (19.1%) of patients developed left ventricular systolic dysfunction [...]

Metabolinio sindromo komponentų ir jų derinių dažnumas tarp vyrų ir moterų, susirgusių ūminiais išeminiais sindromais

During the last decade, it has been shown that the metabolic syndrome and its different components – arterial hypertension (AH), abdominal obesity (AO), diabetes mellitus (DM), atherogenic hypertriglyceridemia (HTG), and/or low concentration of high-density lipoprotein cholesterol (HDL-C)) – increase the risk of cardiovascular diseases. There is increasing evidence that the incidence of the metabolic syndrome and the distribution of its components in combinations in the general male and female population differ. The aim of our study was to determine the incidence of the metabolic syndrome in men and women with acute ischemic syndromes and to evaluate the distribution of the metabolic syndrome component combinations in the presence of the metabolic syndrome. Contingent and methods. The study included 2756 patients (1670 males and 1086 females) with acute ischemic syndromes (1997 with myocardial infarction and 759 with unstable angina pectoris), in whom all five components of the metabolic syndrome were assessed. Women were significantly older than men (68.1±9.5 vs. 60.2±11.8 years, P<0.001). The metabolic syndrome was found (according to modified NCEP III) in 1641 (59.5%) patients (in 70.2% of females and in 52.6% of males, P<0.001). The most common components in both men and women were AH and AO (94.0% vs. 95.9% and 86.4% vs. 84.5%, respectively). HTG was significantly more common in men than in women (80.0% vs. 73.0%, P<0.001), while decreased HDL-C concentration was more common in women (82.8% and 59.2%, P<0.001). The DM component, detected in more than one-third of patients with acute ischemic syndromes, was significantly more common in women than in men (39.2% vs. 33.1%, P<0.05). Combinations of three components were significantly more common in men than in women, while combinations of four–five components were more common in women (55.6% vs. 41.4%, P<0.001; and 58.6% vs. 44.4%, P<0.01) [...]