Albinas Naudžiūnas

Comparison of the improvement in myocardial perfusion and function in cases of rapid and slow electrocardiographic stage dynamics between patients with TIMI-3 flow after primary angioplasty for acute myocardial infarction

BACKGROUND AND OBJECTIVE Post-PCI TIMI flow grade 3 in infarct-related artery not always is associated with follow-up improvement in myocardial perfusion and function. We compared the improvement in myocardial perfusion and function in cases of rapid and slow electrocardiographic (ECG) stage dynamics between patients with TIMI-3 flow after primary angioplasty for acute myocardial infarction (MI). MATERIALS AND METHODS Ten patients with post-PCI TIMI-3 flow were divided into group A (n=50, no rapid change of ECG stages) and group B (n=50, with a ≥2 ECG stages per 2 days change rate). RESULTS There were no significant changes after 3 months in scintigraphic (ejection fraction 44.6±9.3% vs. 42.0±3.4%, P=0.4; perfusion deficit severity 3.0±0.7 vs. 2.3±0.8, P=0.1) and echocardiographic (dysfunction score 1.9±0.2 vs. 1.6±0.5, P=0.2) data in group A. Scintigraphic data improved (ejection fraction 34.6±3.9% vs. 52.0±7.3, P=0.03; perfusion deficit severity 2.8±0.6 vs. 1.5±0.8, P=0.03) and changes in echocardiographic data were of borderline significance (dysfunction score 1.8±0.2 vs. 1.4±0.4, P=0.06) in group B. CONCLUSIONS There was not any change in myocardial perfusion and function in a case of slow change of ECG stages after reached post-PCI TIMI flow grade 3, while myocardial perfusion improved and function tended to improve in a case of the rate at least two ECG stages in 2 days after primary angioplasty for acute MI.

Applicability of Impedance Cardiography During Heart Failure Flare-Ups

Background Heart failure (HF) accounts for about 5% of all causes of urgent hospital admissions, and the overall mortality of HF patients within 1 year after hospitalization is 17–45%. Transthoracic impedance cardiography (ICG) is a safe, non-invasive diagnostic technique that helps to detect various parameters that define different cardiac functions. The aim of this study was to investigate the value of ICG parameters in patients hospitalized due to HF flare-ups. Material/Methods The study included 60 patients (24 women and 36 men) who were admitted to intensive care units because of an acute episode of HF without signs of myocardial infarction. The diagnosis of HF as the main reason for hospitalization was verified according to the universally accepted techniques. ICG data were compared to those obtained via other HF diagnostic techniques. Results A moderately strong relationship was found between the ejection fraction (EF) and the systolic time ratio (STR) r=−0.4 (p=0.002). Findings for STR and thoracic fluid content index (TFCI) differed after dividing the subjects into groups according to the EF (p<0.05). A moderately strong relationship was found between brain natriuretic peptide and TFCI r=0.425 (p=0.001), left cardiac work index (LCWI) r=−0.414 (p=0.001). Findings for TFCI, LCWI, and cardiac output differed after dividing the subjects into groups according to HF NYHA classes (p<0.05). Conclusions Transthoracic impedance cardiography parameters could be applied for the diagnostics and monitoring of HF, but further studies are required to evaluate the associations between ICG findings and HF.

Impedance plethysmography as an alternative method for the diagnosis of peripheral arterial disease.

BACKGROUND AND OBJECTIVE In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index (ABI) is considered as the standard, and other noninvasive methods have received too little attention. Therefore, the aim of the study was to determine the diagnostic accuracy of impedance plethysmography in diagnosing PAD and to compare this method with other methods. MATERIALS AND METHODS A total of 66 patients with a mean age of 76.1±9.6 years who had been treated for various cardiovascular diseases at Kaunas Clinical Hospital during 2011-2012 were enrolled into the study. All the patients were screened for PAD. Impedance plethysmography was performed with a new-generation Niccomo™ device. The receiver operating characteristic analysis was employed to determine the diagnostic accuracy of 4 parameters of impedance plethysmography: crest time (CT), crest width (CW), pulse amplitude (Pampl), and alternating blood flow (ABF). RESULTS There were a significant correlation between the ABI and the CT (r=-0.699, P<0.001), between the ABI and the ABF (r=0.552; P<0.001), and between the ABI and the Pampl only among men (r=0.652; P<0001). No correlation was found between the ABI and the CW. Among all the parameters, the CT had the highest sensitivity and specificity (73.2% and 96.0%, respectively). Other parameters had the following sensitivities and specificities: ABF, 61.0% and 96.0%; and Pampl, 90.0% and 20.0%, respectively. CONCLUSIONS Impedance plethysmography, especially its parameter CT, is an alternative noninvasive method in diagnosing PAD and could be used for the screening of patients with PAD.

Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways

Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

Use of interferon-gamma release assay and tuberculin skin test in diagnosing tuberculosis in Lithuanian adults: A comparative analysis

BACKGROUND AND OBJECTIVE Lithuania belongs to the group of countries with a high-incidence of tuberculosis (TB). Some scientific studies show that the interferon-gamma release assay is more accurate and correlates more highly with TB exposure as compared to the tuberculin skin test (TST). This study aimed at comparing the efficacy between the T SPOT TB and TST for diagnosing TB among Lithuanian adults. MATERIALS AND METHODS Individuals with diagnosed TB, healthcare workers with known risk for TB and individuals without any known risk for TB underwent clinical examinations, interviews about their history of TB exposure and chest radiography. Then the TST and the T SPOT TB were performed on patients. RESULTS A positive T SPOT TB was more common in the group with diagnosed TB compared to healthcare workers and the low risk for TB groups (97.5%, 36.4%, and 0%, respectively, P<0.01). Positive TST results did not differ between the groups with diagnosed TB and the healthcare workers (92.5% vs. 95.5%, P>0.05). Agreement between TST and T SPOT TB was poor (kappa 0.14, P>0.05). T SPOT TB had higher specificity and sensitivity compared to TST (area under the ROC 0.9±0.04, P<0.01, vs. 0.5±0.06, P>0.05). CONCLUSIONS The T SPOT TB showed greater accuracy in diagnosing TB than TST did. Positive T SPOT TB result but not the TST was more common in patients with diagnosed TB.

Impedanskardiografijos metodo galimybės diagnozuojant plaučių hipertenziją

Tyrimo tikslas. Istirti klinikinių, impedanskardiografijos, echokardioskopijos, krūtinės ląstos rentgenografijos duomenų sąsajas diagnozuojant plaucių hipertenziją sergantiesiems sirdies ir kraujagyslių arba kvėpavimo sistemų ligomis. Tyrimo medžiaga ir metodai. 181 pacientui (80 pacientų, sergancių sirdies ir kraujagyslių sistemos patologija, kai echokardioskopiskai nustatyta plaucių arterijos hipertenzija; 69 pacientams, sergantiems sirdies ir kraujagyslių sistemos patologija, kai echokardioskopiskai plaucių arterijos hipertenzijos nerasta; 19 pacientų, sergancių plaucių patologija, kai echokardioskopiskai plaucių arterijos hipertenzijos rasta; 13 pacientų, sergancių plaucių patologija, kai plaucių arterijos hipertenzijos nerasta) istirti buvo taikomi klinikiniai, dvimatės sirdies echoskopijos, impedanskardiografijos, kiti instrumentiniai tyrimai siekiant įvertinti, serganciųjų plaucių hipertenzija duomenų pokycius. Rezultatai. Impedanskardiografijos metodo jautrumas, diagnozuojant plaucių hipertenziją pagal vidutinį kraujo spaudimą plaucių arterijoje, 72 proc., specifiskumas – 90 proc., pagal sistolinį kraujo spaudimą plaucių arterijoje jautrumas – 96 proc., specifiskumas – 90 proc. Sudarytas matematinis dvejetainės logistinės regresijos modelis, pagal kurį 96,7 proc. tikslumu galima diagnozuoti plaucių hipertenziją. Svarbiausi impedanskardiografijos duomenys: sistolinis spaudimas plaucių arterijoje bei sistolinio laiko indeksas. Isvados. Impedanskardiografijos tyrimo metu nustatomi vidutinio ir sistolinio kraujo spaudimo plaucių arterijoje parametrai yra informatyvūs. Plaucių hipertenzijos diagnostikos algoritmuose galima būtų naudoti siuos požymius: priesirdžių virpėjimas, giliųjų venų trombozė, dusulys, cianozė, II tono akcentas plaucių arterijos vožtuvo isklausymo taske, sistolinis ūžesys ties triburiu vožtuvu, plaucių rentgenografijoje rastas padidėjes plaucių arterijos spindis ≥18 mm, padidėjes desiniojo skilvelio diametras, impedanskardiografijos metodu apskaiciuotas sistolinis spaudimas plaucių arterijoje bei sistolinio laiko indeksas.