V. Stoickov

Significance of asymptomatic hyperuricemia in patients after coronary events

Abstract The goal of the present study was to determine the prevalence of hyperuricemia in patients with coronary artery disease (CAD), within three months after coronary events. Also, we aimed to determine whether the presence of hyperuricemia holds correlation with severe CAD, overall heart functioning and risk factors for CAD. The study included 505 consecutive CAD patients, 385 males and 120 females, aged 60.9 ± 9.6 years, with a mean body mass index (BMI) 28.0 ± 3.7 kg/m2. All patients were admitted to specialized cardiovascular rehabilitation within three months post-acute myocardial infarction (AMI) without revascularization (32.6%), percutaneous coronary intervention (PCI) with myocardial infarction (32.1%) and with coronary bypass graft (35.3%). The mean value of serum acidum uricum (SUA) was 345.5 ± 100.3 µmol/L, where 115 (22.8%) patients had asymptomatic hyperuricemia. Patients with asymptomatic hyperuricemia had significantly higher average number of risk factors, lower HDL cholesterol and higher creatinine and triglycerides levels, lower ejection fraction (EF). Multivariate stepwise analysis revealed that five parameters were capable to predict SUA levels. We can conclude that in patients with CAD, SUA levels are independently associated with BMI, triglyceride and creatinine levels and negatively with EF. Thus, one can say that asymptomatic hyperuricemia is not significantly associated with the severity of CAD.

IMPACT OF SHORT-TERM EXERCISE TRAINING ON ARTERIAL BLOOD PRESSURE AND QT DISPERSION IN DIABETIC PATIENTS AFTER MYOCARDIAL INFARCTION

Objective: The aim of this study was to establish the influence of short-term exercise training on arterial blood pressure and QT dispersion in diabetic patients after myocardial infarction. Design and method: The study involved 139 diabetic patients after myocardial infarction (average age 55.7 years), in the sinus rhythm without AV blocks or branch blocks. Patients were randomly divided into the physical training group (TG: 115 patients) and non-training group (NTG: 24 patients). Patients were of similar age, site of infarction and baseline stress test duration. In all subjects standard ECG and exercise test on treadmill were performed and after that TG patients were included in a training program for three weeks. TG patients were instructed to follow a training program using the bicycle ergometer (10 min, 2 times a day), gymnastic exercises, and walking. The patients continued to take the same medicaments in same doses. From standard ECG corrected QT dispersion (QTdc) was calculated. Results: After program of physical training in TG of patients, significant reduction of QTdc was found, from 81.9 ± 24.8 to 73.5 ± 23.7 ms; p < 0.01. Also, in TG of patients, after program of physical training, we have found significant reduction of systolic blood pressure from 137.6 ± 12.9 to 128.4 ± 12.1 mmHg; p < 0.001; of diastolic blood pressure from 87.1 ± 7.9 to 82.9 ± 9.1 mmHg; p < 0.001 and of double product from 12834.6 ± 1975.2 to 11392.1 ± 1684.3 beat/min x mmHg; p < 0.001. In TG of patients, after program of physical training, significant reduction of glycemia was found, from 7.9 ± 2.9 to 6.9 ± 1.9 mmol/L; p < 0.005. In contrast, NTG of patients showed no significant changes. Conclusions: Short-term exercise training has favourable effects on arterial blood pressure and QT dispersion in diabetic patients after myocardial infarction. Physical training led to the significant decrease of myocardial oxygen uptake at rest and probably decreased the possibility of arrhythmia events in diabetic patients after myocardial infarction.

The anesthetic action of some polyhalogenated ethers—Monte Carlo method based QSAR study

Up to this date, there has been an ongoing debate about the mode of action of general anesthetics, which have postulated many biological sites as targets for their action. However, postoperative nausea and vomiting are common problems in which inhalational agents may have a role in their development. When a mode of action is unknown, QSAR modelling is essential in drug development. To investigate the aspects of their anesthetic, QSAR models based on the Monte Carlo method were developed for a set of polyhalogenated ethers. Until now, their anesthetic action has not been completely defined, although some hypotheses have been suggested. Therefore, a QSAR model should be developed on molecular fragments that contribute to anesthetic action. QSAR models were built on the basis of optimal molecular descriptors based on the SMILES notation and local graph invariants, whereas the Monte Carlo optimization method with three random splits into the training and test set was applied for model development. Different methods, including novel Index of ideality correlation, were applied for the determination of the robustness of the model and its predictive potential. The Monte Carlo optimization process was capable of being an efficient in silico tool for building up a robust model of good statistical quality. Molecular fragments which have both positive and negative influence on anesthetic action were determined. The presented study can be useful in the search for novel anesthetics.

[PP.04.24] THE IMPACT OF HYPERTENSION ON QT DISPERSION AND ECHOCARDIOGRAPHIC PARAMETERS IN PATIENTS WITH ANGINA PECTORIS

Objective: Introduction: QT dispersion (QTd) is a measure of inhomogeneous repolarization of myocardium and is used as an indicator of arrhythmogenicity. According to the values of QTd can identify coronary patients who are at high risk of cardiac death and sudden cardiac death. Objective: The aim of this study was to investigate the effect of hypertension on QT dispersion and echocardiographic parameters in patients with angina pectoris. Design and method: The study included 113 patients with angina pectoris (average age 57.2 years), of which 78 were with hypertension, and 35 were without arterial hypertension. There were no significant differences in age and gender between the two groups of patients. In all subjects exercise stress test on a treadmill according to the Bruce protocol and echocardiographic examination were performed and from standard ECG corrected QT dispersion (QTdc) and QTd was calculated. Results: Patients with angina pectoris and hypertension had significantly higher values of QTd (55.1 ± 17.1 vs 42.8 ± 19.5 ms; p < 0.01) and QTdc (59.2 ± 20.0 vs 45.5 ± 18.1 ms; p < 0.001) compared to those without arterial hypertension. Also, patients with angina pectoris and hypertension had significantly higher values of the thickness of the interventricular septum (12.1 ± 2.1 vs 10.8 ± 1.7 mm; p < 0.005), left ventricle posterior wall thickness (10.9 ± 1.5 vs 9.2 ± 1.4 mm; p < 0.001) and left atrium diameter (40.9 ± 4.8 vs 37.3 ± 5.4 mm; p < 0.005) compared to those without hypertension. Patients with angina pectoris and arterial hypertension have higher values of the left ventricular end-diastolic diameter (54.1 ± 5.8 vs 53.7 ± 7.1 mm; p-NS), and left ventricular end-systolic diameter (36.6 ± 6.1 vs 35.8 ± 6.9 mm; p-NS) and lower values of left ventricular ejection fraction (60.9 ± 11.2 vs 63.6 ± 11.9%; p-NS), but the differences were not statistically significant. Conclusions: The study demonstrated that patients with angina pectoris and hypertension have significantly higher values of QT dispersion parameters, thickness of the left ventricle walls and left atrium diameter in comparison to those without hypertension.

The influence of type 2 diabetes mellitus on the frequency and complexity of ventricular arrhythmias and heart rate variability in patients after myocardial infarction

Background/Aim After myocardial infarction arrhythmic cardiac deaths are significantly more frequent compared to non-arrhythmic ones. The aim of the study was to investigate the influence of type 2 diabetes mellitus (T2DM) on the frequency and complexity of ventricular arrhythmias after myocardial infarction. Methods The study included 293 patients, mean age 59.5 ± 9.21 years, who were at least six months after acute myocardial infarction with the sinus rhythm, without atrioventricular blocks and branch blocks. In the clinical group 95 (32.42%) patients were with T2DM, while 198 (67.57%) patients were without diabetes. All of the patients were subjected to the following procedures: standard ECG according to which the corrected QT dispersion (QTdc) was calculated, exercise stress test, and 24-hour holter monitoring according to which, the four parameters of time domain of heart rate variability (HRV) were analyzed: standard deviation of all normal RR intervals during 24 hours (SDNN), standard deviation of the averages of normal RR intervals in all five-minute segments during 24 hours (SDANN), the square root of the mean of the sum of the squares of differences between adjacent normal (RMS-SD), and percentage of consequtive RR intervals which differed for more than 50 ms during 24 hours (NN > 50 ms). Results In patients after myocardial infarction, patients with T2DM had significantly higher percentage of frequent and complex ventricular arrhythmias compared to the patients without diabetes (p < 0.001). The patients with T2DM had significantly higher percentage of residual ischemia (p < 0.001), and arterial hypertension (p < 0.001), compared to patients without diabetes. The patients with T2DM had significantly lower values of HRV parameters: SDNN (p < 0.001); SDANN (p < 0.001); RMS-SD (p < 0.001), and NN > 50 ms (p < 0.001), and significantly higher values of QTdc (p < 0.001) compared to the patients without diabetes. Conclusion The study showed that type 2 diabetes mellitus has significant influence on ventricular arrhythmias, HRV parameters and QT dispersion in patients after myocardial infarction.

Acute Myocardial Infarction with an Initially Non–Diagnostic Electrocardiogram – Clinical Intuition is Crucial for Decision Making

Summary Acute myocardial infarction (AMI) is a common cause of reduced cardiac capacity and functional status of a patient. Successful primary percutaneous coronary intervention (pPCI) in acute coronary syndrome and appropriate, complex cardiovascular rehabilitation play a major role in preserving left ventricular function and improvement of prognosis and quality of patient’s life. The aim of this paper was to present a clinical course in a patient with acute myocardial infarction who did not have a classic ECG presentation in the form of ST-segment elevation. We showed that in everyday clinical work it is essential to timely recognize the symptoms of acute myocardial infarction, make the proper diagnosis and perform right treatment strategy. The next step is cardiovascular rehabilitation program, which positive effects, in our patient, was achieved through the retrieval of functional capacity and correction of risk factors. Sažetak Akutni infarkt miokarda (AIM) je čest uzrok smanjenog kardijalnog kapaciteta i funkcionalnog stanja bolesnika. Uspešna primarna perkutana koronarna intervencija (pPCI) u akutnom koronarnom sindromu i adekvatna, kompleksna kardiovaskularna rehabilitacija imaju veliku ulogu u očuvanju funkcije leve komore i poboljšanju prognoze i kvaliteta života bolesnika. Cilj rada bio je prezentacija kliničkog toka kod bolesnika sa akutnim infarktom miokarda koji nije imao klasičnu EKG prezentaciju u formi elevacije ST segmenta. Pokazali smo da je u svakodnevnom kliničkom radu najbitnije pravovremeno prepoznavanje simptoma akutnog infarkta miokarda, što olakšava postavljanje prave dijagnoze i izbor prave terapijske strategije. Sledeći korak je program kardiovaskularne rehabilitacije, koja je svojim pozitivnim efektima kod našeg bolesnika ostvarila popravljanje funkcionalnog kapaciteta i korekciju faktora rizika.

COMBINED ACE INHIBITOR AND STATIN THERAPY IN HYPERTENSIVE DIABETIC PATIENTS PRIOR TO ACUTE MYOCARDIAL INFARCTION HAVE PROTECTIVE EFFECTS ON HOSPITAL MORBIDITY AND MORTALITY: PP.5.200

Objective: To determine whether administration of combined ACE inhibitor and statin therapy prior to acute myocardial infarction (MI) is related to infarct size and hospital cardiovascular morbidity and mortality. Methods: Study population consisted of 232 consecutive hypertensive diabetic patients admitted with a diagnosis of acute MI. Outcome data were compared between groups of patients receiving ACE inhibitor prior to infarction (ACEI group, n=140) and those who received ACE inhibitor and statin therapy, at least 3 months prior to infarction (ACEIS group, n=92). Results: There were not significant differences in regard to age, sex, site of infarction, aspirin therapy, and value of blood pressure between ACEI and ACEIS group. Patients in ACEIS group experienced smaller MI size, determined by peak creatine kinase elevation (P < 0.05), and by wall motion score (13.7 ± 1.7 vs 14.2 ± 2.0; P < 0.05) than patients in ACEI group. Left ventricular ejection fraction was higher in ACEIS group than in ACEI group (47.7 ± 7.1 vs 45.9 ± 8.6%;NS). In patients in ACEIS group, intra-hospital cardiovascular events were less frequent than in ACEI group: heart failure (12% vs 18%), re-infarction (6% vs 9%), recurrent angina (9% vs 13%), vascular death (5% vs 8%). Conclusion: Our data showed that hypertensive diabetic patients who experience an acute MI, those receiving prior combined ACE inhibitor and statin therapy have smaller infarct size, better global systolic function, less hospital morbidity and mortality. Thus prior combined ACE inhibitor and statin therapy has cardioprotective effect in hypertensive diabetic patients with acute myocardial infarction.