A.Z. Pietrucha

Endothelial function in vasovagal syncope.

Vasovagal syncope (VVS) is a common form of fainting. The pathophysiology of VVS is complex and involves changes in the autonomic and vascular tone, resulting in reflex bradycardia with marked hypotension. Paradoxical peripheral vasodilation caused by endothelial dysfunction may also play a key role in inappropriate hypotension during VVS. Endothelial hyperactivity due to up regulation of nitric oxide synthase leads to profound vasodilation, much stronger than vasodilation caused by adrenergic stimulation in response to orthostatic stress alone. Studies have reported significantly higher flow-mediated dilation and higher plasma nitric oxide concentration in people with vasovagal syndrome. Patients with VVS showed decreased vasoconstrictive agent endothelin-1 levels during orthostatic stress. Coagulation and fibrinolysis activity also play important roles in endothelial function in syncopal patients. The response of the endothelium to orthostatic stress is similar to the reaction to haemorrhagic stress and is likely to be a remnant from the evolutionary adaptation of primates.

Analysis of Circadian Distribution of Premature Ventricular Contractions in Patients After Heart Transplantation

The aim of our study was to analyze circadian distribution of premature ventricular contractions (PVC) and its coupling interval (CI) in patients after orthotopic heart transplantation (HTx). Forty‐two patients (5 females, 37 males) were monitored from 2 weeks to 5 years after HTx; 180 24‐hour Holter ECG studies were performed. All recordings were divided into two groups: group I, within 1 month after HTX; and group II, after 1 month. Patients with more than 250 PVC/24 hours were selected for distribution of PVC and CI evaluation. Conclusions: Ventricular arrhythmias occur frequently in patients after heart transplantation. In patients with high Lown scale arrhythmias low occurrence (< 250/24 hours) of PVC was frequently observed (IVa: 81.8%; IVb: 84.7%). Similar patterns of circadian distribution (CD) of PVC and CD of HR in denervated heart after HTx suggest the influence of circulating catecholamines on their occurrence.

The influence of obesity on progression of coronary arteriosclerosis and clinical course after ST elevation acute myocardial infarction treated with primary coronary interventions

PURPOSE Evaluation of influence of obesity on the coronary atherosclerosis development and clinical outcome in patients with STEMI treated by PCI with BMS implantation. MATERIAL AND METHOD 82 patients (64 men) treated with PCI within 6 hours from 1st STEMI. Three groups of pts were formed according to BMI. Based on coronary angiography number of significant stenoses (NSS), number of stenosed coronary arteries (NSA), and sum of significant stenoses (SSS) were calculated. Echocardiography examination was performed 3 days and 6 months after STEMI. Serial evaluation of TnI, CK, CKMB was performed after admission, and serum BNP was assessed after 2 days, 1 and 6 months after STEMI. RESULTS Obese patients revealed higher values of NSA, NSS and SSS than patients with normal BMI and overweight. There were no differences of BNP, maximal values and AUC of CK, CKMB, TnI and echocardiographic parameters between all groups whereas decrease of BNP during follow-up correlated with BMI. CONCLUSIONS Results of our prospective study indicate that in obese patients, there is a significantly greater number of atherosclerotic lesions in coronary arteries found during PCI, as compared to those with normal body weight or overweight. We proved that overweight and obesity did not result in significantly greater damage to the myocardium and left ventricular dysfunction, both in the acute phase and 6 months after myocardial infarction treated with primary coronary intervention, as compared to those with normal body weight. In addition correlation was found between BNP concentration profile and body mass index in the 6-month follow-up after STEMI treated with PCI and bare metal stent implantation.

How does the estimated phase of menstrual cycle or menopause influence the prevalence of vasovagal syncope induced by head-up tilt test

BACKGROUND The purpose of this study was to evaluate the prevalence of syncope induced by head-up tilt test (HUTT) and the type of positive vasovagal response to the orthostatic stress in a relationship to the estimated phase of menstrual cycle (follicular phase, luteal phase) or menopause. METHODS We observed a cohort of 500 women at age 13-89 years (median of age 37.5), referred to HUTT. Phase of the menstrual cycle was determined on the basis of the usual length of menstrual cycle and the day of the cycle at the time of the study. We assumed that the length of the luteal phase is constant and it is 14 days. RESULTS In premenopausal patients, the occurrence of the mixed and cardioinhibitory response was significantly more frequent in comparison to postmenopausal women (48.8 vs. 35.1% and 19.7 vs. 12.4%, respectively; p < 0.00001), while the occurrence of the vasodepressive one was significantly less frequent (7.3% vs. 28.6%; p < 0.00001) in that group of patients. Women in follicular phase presented vasodepressive response during HUTT more often than woman in the luteal phase (10.0% vs. 4.1%, p < 0.00001). CONCLUSIONS Among women referred for HUTT, the prevalence of the vasovagal syndrome did not differ between those that were pre- and post-menopausal. Higher incidence of vasodepressive reaction in postmenopausal women was observed. Among the premenopausal women, the vasodepressive type of vasovagal syndrome occurred more often in follicular then in luteal phase.

P-57 Evaluation of Plasma Renin Activity in Acute MI Patients Treated with Primary Percutaneous Coronary Interventions

Aim of Study: Evaluation of plasma renin activity in patients with acute myocardial infarction AMI) treated with primary percutaneous coronary interventions (PCI). We observed 62 pts, (39 man) aged 38 75 yrs with first AMI treated with PCI. Plasma renin activity (PRA) was evaluated on 1st, 3rd and 5th day and 1st and 3rd month after AMI in all pts. Anthropometric parameters: BMI, body weight and body fat concentration, Serum NTproBNP and hsCRP Max TnI concentration, maximal activity of CK and CK-MB were measured within short post-AMI period. Echocardiography with evaluation left ventricles function were performed at 3rd day, 1st and 3rd month after AMI. Cardio-pulmonary exercise test was performed after 3 months of follow-up. Results: Mean value of PRAwas 2.8 at 1st day; 3.4 at 3rd day; 4.5 at 5th day; 4.7 at 1 month, and 3.6 ng/ml/h at 3 months after AMI. Mean valuees of PRA was significantly lower in women than in men only at 1st day (0.9 vs 3.5 ng/ml/h; p = 0.01). Peak value of PRA was observed between 5th day and 1st month after AMI. Values of PRA correlate with serum NTproBNP, body fat concentration, RV diameter and tricuspid annular plane systolic excursion TAPSE. Conclusions: 1. PRA was significantly higher in men than in women at 1st day of acute MI treated with primary PCI. 2. Values of PRA changes within early period after AMI with peak value between 5th day and 1st month after AMI. 3. Values of PRA correlate with serum level of NTproBNP at 1st day of AMI and echocardiography parameters of right ventricle function with 3 month follow up in this group of patients.

P-58 Level of Dehydroepiandrostendione Sulfate in Patients with Acute MI Treated with Primary PCI

Aim of Study: Evaluation of plasma renin activity in patients with acute myocardial infarction AMI) treated with primary percutaneous coronary interventions (PCI). We observed 62 pts, (39 man) aged 38 75 yrs with first AMI treated with PCI. Plasma renin activity (PRA) was evaluated on 1st, 3rd and 5th day and 1st and 3rd month after AMI in all pts. Anthropometric parameters: BMI, body weight and body fat concentration, Serum NTproBNP and hsCRP Max TnI concentration, maximal activity of CK and CK-MB were measured within short post-AMI period. Echocardiography with evaluation left ventricles function were performed at 3rd day, 1st and 3rd month after AMI. Cardio-pulmonary exercise test was performed after 3 months of follow-up. Results: Mean value of PRAwas 2.8 at 1st day; 3.4 at 3rd day; 4.5 at 5th day; 4.7 at 1 month, and 3.6 ng/ml/h at 3 months after AMI. Mean valuees of PRA was significantly lower in women than in men only at 1st day (0.9 vs 3.5 ng/ml/h; p = 0.01). Peak value of PRA was observed between 5th day and 1st month after AMI. Values of PRA correlate with serum NTproBNP, body fat concentration, RV diameter and tricuspid annular plane systolic excursion TAPSE. Conclusions: 1. PRA was significantly higher in men than in women at 1st day of acute MI treated with primary PCI. 2. Values of PRA changes within early period after AMI with peak value between 5th day and 1st month after AMI. 3. Values of PRA correlate with serum level of NTproBNP at 1st day of AMI and echocardiography parameters of right ventricle function with 3 month follow up in this group of patients.

3. Vasovagal Syncope, Tilt Testing

The aim of study was to evaluate a psychological profile (PSP) of patients with diagnosed vaso-vagal syncope (VVS). We observed 30 pts. (12 men and 18 women), aged 19-61 yrs, with history of neurocardiogenic syncope (NS) and positive head-up tilt test (HUTT) acc. to Westminster protocol. All patients, before HUTT, underwent psychological evaluation with the packet of the following tests: Based on results of mentioned tests psychological profile of each patient was performed. Results Vaso-depressive VVS was diagnosed in 17 pts, cardio-inhibitory VVS – 1 pt and mixed VVS 12 pts. There were achieved the following mean results of performed psychological tests: Conclusions Psychological characteristics of patients with vaso-vagal syncope is characterised by:-a reduction in the health related quality of life, -a slight increase in anxiety level and an increase in inner tension, -a slight increase in anxiety level is a result of an increase in inner tension which itself is a result of an inner conflict between urges and a restrictive superego.

The Value of Electrophysiological Testing in Diagnosis of Syncope in Post-infarction Patients, without Complex Ventricular Arrhythmias Detected in 24-hour ECG

The most frequent reasons for syncope in patients after myocardial infarction are complex ventricular arrhythmias (CVA)1–4. Ventricular arrhythmias (VA) are present in approximately 20–50% of patients after myocardial infarction5. On the other hand 90% of sudden cardiac death episodes are caused by VA6. Most patients present with VA in standard 12-lead ECG or in 24-h ECG Holter monitoring. However, in some patients after myocardial infarction, detection of VA is impossible, in spite of repetitive 24-h ECG recordings. In these patients we may observe only symptoms related to VA, such as syncope, presyncope or vertigo. These patients are thus especially in danger of sudden cardiac death because of the impossibility of arrhythmia mechanism assessment; 24-h ECG Holter monitoring is not a sufficient diagnostic tool in such cases. Improvement of suitable diagnostic procedures, for instance programmed electrical stimulation (PES), in this group of patients after myocardial infarction, is very important both for defining the very high sudden cardiac death risk patients and for sufficient anti-arrhythmic treatment7,8.