The aim of this study was to investigate the effect of 3-weeks stationary cardiac rehabilitation on plasma lipids level in patients with CHD. The study included 444 consecutive patients (364 male and ...80 female, mean age 58 +/- 9 year) with CHD who underwent 3-weeks stationary cardiac rehabilitation. Patients were divided into groups depending on their baseline levels of cholesterol and medication therapy: patients with normal (< 5 mmol/L, group I, 129 patients) and elevate plasma level of Total cholesterol (> 5 mmol/L, group II, 315 patients) and subgroups Ia and IIa (with statin in therapy), Ib and IIb (without statin in therapy). After 3-weeks cardiac rehabilitation, the levels of Total cholesterol 5.75 +/- 1.34 vs. 5.17 +/- 1.08 mmol/l; p < 0.001, triglycerides 2.04 +/- 1.33 vs. 1.81 +/- 1.06 mmol/L; p = 0.004, LDL-cholesterol 3.77 +/- 1.14 vs. 3.21 +/- 0.96 mmol/L; p < 0.001 were significantly lower while the level of HDL-cholesterol 0.94 +/- 0.28 vs. 0.99 +/- 0.27 mmol/L; p = 0.008 were significantly higher in comparison with the baseline values. Furthermore, we found significant changes in lipid profile at the end of rehabilitation in each group of patients compared with the baseline values. There were no significant differences in plasma lipids level between group of patients with or without statin in therapy at the end of rehabilitation. The results of this study suggest that moderate regular physical activity and diet alone or in combination with hypolipidemic drugs already after 3 weeks have a favourable effect on plasma lipids level and should be propagate in the prevention of CHD.
Recently published studies suggest that percutaneous coronary inetrvention (PCI) is superior to fibrinolysis in terms of early and late mortality in patients with acute myocardial infarction (MI) ...with ST-elevation. The aim of this study was to evaluate the influence of treatment strategy in the acute phase of MI on postinfarction functional capacity.
This prospective study included 128 consecutive patients with MI, with ST-elevation over 12 weeks from the disease onset. There were 92 (72%) male and 36 (28%) female patients, mean age 59 +/- 10 years. Inclusion criteria were age under 70, first MI with ST-elevation, and sinus rhythm. Exclusion criteria were previous MI, non ST-elevation MI, acute heart failure, atrial fibrillation, unstable angina pectoris, re-IM or necessity for coronarography and PCI during rehabilitation, and other acute disease. Patients were divided into three groups according to treatment modality: group 1, 38 (30%) patients treated with primary PCI; group 2, 46 (36%) patients treated with fibrinolysis; and group 3, 44 (34%) conservatively treated patients. There were no significant between-group differences according to age, sex, risk factors for coronary artery disease, infarct site, and frequency of complications in the acute phase of MI. The functional capacity of patients was evaluated by symptom-limited exercise test. Echocardiographic examinations were also done in each patient. Statistical analysis was performed by using the commercial software package, Microsoft SPSS for Windows, Version 8.0. Results were expressed as a mean standard deviation. Differences between the groups were tested by analysis of variance (ANOVA) and post hoc Tuckey test. The value of p < 0.05 was considered statistically significant.
At the end of rehabilitation, the mean values of exercise capacity in groups 1, 2 and 3 were 6.1 +/- 1.3, 5.5 +/- 1.2, and 4.8 +/- 1.3 METs, respectively (group 1 vs. 2, p = 0.03; group 1 vs. 3, p < 0.001; group 2 vs. 3, p = 0.01). The mean values of ejection fraction in groups 1, 2 and 3 were 56 +/- 10, 53 +/- 9 and 47 +/- 11, respectively (group 1 vs. 2, p = 0.03; group 1 vs. 3, p < 0.001: group 2 vs. 3, p = 0.009). Four (3%) patients were excluded from the study because of complications during rehabilitation treatment.
Postinfarction functional capacity in patients with MI depends on treatment strategy in the acute phase of disease. Patients who underwent PCI in the acute phase of MI had a higher functional capacity and better preserved systolic function of the left ventricle in comparison with patients who received fibrinolysis or those who were treated conservatively.
Heart rate variability (HRV) is a physiological phenomenon which reflects the influence of the autonomic nervous system on the heart work. The research in HRV has not been limited to the domain of ...basic and clinical cardiology, mostly with the aim of stratifying the risks of sudden death from malignant arrhythmias among patients with myocardial infarction (MI), but over the past few years the research has been done and studies have been published also in the area of neurology. Likewise acute MI, acute ischemic stroke leads to autonomic dysbalance and lowered HRV. However, literature lacks relevant data on autonomic dysbalance after the acute phase of ischemic stroke. The aim of this study was to assess the level of autonomic dysbalance in patients after the acute phase of ischemic stroke.
This prospective study included 86 consecutive patients who had suffered ischemic stroke (59 men and 27 women, mean age 56 +/- 13 years) and 86 age-matched healthy control subjects (62 men and 24 women, mean age 53 +/- 9 year). In the acute phase of the disease, along with clinically manifest neurologic deficit, there is ischemic hemispheric lesion verified by computed tomography (CT) scan. Lesion of the left and right cerebral hemisphere was detected in 56% and 44% of patients, respectively. After the acute phase of the disease, patients were hospitalized at one of the neurologic departments of the Hospital for Medical Rehabilitation in Krapinske Toplice, Croatia, where rehabilitation was carried out (mean duration 20 +/- 9 days) in the 1999-2002 period. Inclusion criteria were: age under 70 years, first ischemic stroke verified by CT scan within 2-12 weeks of the acute phase of the disease, Barthel index 30-50, and stable sinus rhythm in ECG. Exclusion criteria were: a history of previous ischemic stroke, intracerebral hemorrhage, MI, percutaneous coronary intervention or surgical revascularization of the myocardium, clinical signs of coronary artery disease, acute heart failure, diabetes mellitus, chronic atrial fibrillation, sinus node disease, AV block grade II or III, and the use of beta adrenergic blockers or antiarrhythmic agents class Ic or III in medication. Twenty-four hour Holter ECG was performed 58 +/- 23 days after the stroke (14 +/- 5 days from the beginning of rehabilitation). HRV was analyzed from the Holter ECG data. The values of the HRV parameters in stroke patients were compared with those recorded in the control group. Most of the variables proposed by the Task Force on HRV were analyzed. Time domain analysis included: mean RR, mean of R-R intervals for normal beats; SDNN, standard deviation of all normal R-R intervals; SDNN-i, mean of 5-minute standard deviations of RR intervals; SDANN-I, standard deviation of the 5-minute means of R-R intervals; rMSSD, square root of the mean of the squared successive differences in R-R intervals; and pNN50, percentage of R-R intervals that are by at least 50 ms different from the previous interval. Frequency domain analysis included: TP, total power (0.0-0.5 Hz); VLF, very low (0.0033-0.04 Hz); LF, low (0.04-0.15 Hz); HF, high (0.15-0.40 Hz) frequency components; and LF/HF, low to high frequency ratio. Statistical analysis was performed using the commercial software package, Microsoft SPSS for Windows, Version 8.0.
Patients who had suffered an ischemic stroke had a significantly lower overall HRV and shorter mean RR interval than healthy subjects from the control group: SDNN 96 +/- 27 vs. 136 +/- 31 ms, p < 0.001; TP 1962 +/- 1338 vs. 3968 +/- 2857 ms2, p < 0.001; and mean RR 869 +/- 104 vs. 892 +/- 117 ms, p = 0.02.
As in MI, the values of HRV stay significantly lower after the acute phase of the disease in patients who have suffered ischemic stroke compared to healthy persons of the same age.
BACKGROUNDHeterophile antibodies are one of the most common causes of false-positive troponin.CASE SUMMARYWe report a case of a 53-year-old woman with false-positive troponin elevation and a clinical ...presentation understood and treated as non-ST-elevation acute coronary syndrome. Because of chronic basal elevation of troponin (at a 'plateau' level) and chest pain, the patient underwent several invasive coronary angiograms until false-positive increase of troponin due to heterophile antibodies was suspected. Borderline stenosis of a left circumflex coronary artery found on first coronary angiogram was a coincidental finding and heterophile antibodies in the patient's serum were confirmed.DISCUSSIONThis interesting case report aims to remind the clinicians about the possibility of false-positive troponin level due to laboratory analytical interference caused by heterophile antibodies. In this case, it is important to suspect false-positive troponin elevation, even when coronary artery disease is found. This rare and less mentioned and/or recognized cause of troponin elevation may lead to unnecessary invasive diagnostics and aggressive treatment of patients.
Bolesnici s koronarnom bolešću starije životne dobi često se ne upućuju na kardiološku rehabilitaciju. Cilj ovoga rada bio je procijeniti učinak trotjedne stacionarne kardiološke rehabilitacije u ...bolesnika s koronarnom bolešću starijih od 70 godina. U studiju je bilo uključeno 103 uzastopnih bolesnika starijih od 70 godina tijekom trotjedne stacionarne kardiološke rehabilitacije. Infarkt miokarda bilo je preboljelo 77% bolesnika, dok ih je 23% bilo prethodno podvrgnuto kirurškoj revaskularizaciji miokarda. Bolesnici koji nisu mogli izvesti ergometrijsko testiranje ili oni s kongestivnim srčanim popuštanjem nisu bili uključeni u studiju. Funkcionalni kapacitet, lipidogram, razina glukoze u krvi, tjelesna težina i indeks tjelesne mase mjereni su prije te odmah nakon završetka rehabilitacije. Nakon trotjedne kardiološke rehabilitacije funkcionalni se kapacitet značajno poboljšao (p<0,0001). Razine kolesterola (p<0,0001), triglicerida (p=0,01), LDL-kolesterola (p<0,0001) i glukoze u krvi (p=0,004) bile su značajno niže u odnosu na početne vrijednosti. Nije bilo značajne razlike u razini HDL-kolesterola, tjelesnoj težini i indeksu tjelesne mase na kraju rehabilitacije u odnosu na početne vrijednosti. Rezultati ovoga rada pokazali su da kardiološka rehabilitacija koristi bolesnicima s koronarnom bolešću starijim od 70 godina, te da ih treba rutinski upućivati i poticati na provođenje ovih programa.
This study was undertaken to evaluate the effect of galanthamine, a new cholinesterase inhibitor on cognitive performances in 84 patients with various apoE genotype and Alzheimer’s disease (AD) ...during the six-month treatment. The diagnosis of AD was made on the basis of NINCDS/ADRDN criteria. ApoE4 genotype was determined by PCR procedure. The cognitive performance was assessed MMSE at baseline and six months later. The difference among the groups was statistically analyzed by ANOVA model and Pearson’s x2-test. The MMSE at baseline in all completes was 18.0 +/- 3.73, whereas the mean value of MMSE after 6 months was 16.4 +/- 5.61 indicating significant deterioration (p < 0.01). Of the 84 patients, 14 (16%) were apoE4 homozygous, 41 (49%) were heterozygous, whereas 29 (35%) were apoE4 negative. The significant number of responders was observed among apoE4 homozygous patients (71%; x2 = 6.89; p = 0.032). The subgroup of apoE4 homozygous patients with AD in its mild to moderate stage may be considered as responders to galanthamine.
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