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Permanent cardiac pacing is a widely applied procedure in invasive cardiology. The aim of our study was the analysis of the localisation of the tip of the pacemaker lead and its course in the right ventricle. Research was carried out on a group of 12 patients (5F, 7M), from 40 to 93 years of age (average 70±15 yrs) with permanent cardiac pacing or implantable cardioverter-defibrillator (ICD). Subsequent echocardiographic views were applied: an apical four chamber view, a subcostal one and a parasternal right ventricular inflow tract view. At the level of the tricuspid annulus the electrode was positioned: the anterior leaflet – 41.7% (5 pts), the anteroseptal commissure 25% (3 pts), the posterior leaflet 8.3% (1 pt) and the septal one – 8.3% (1 pt). In 16.7% (2 patients) the lead was positioned centrally in the right atrioventricular orifice. Regarding the further positioning of the electrode in the ventricle, in 41.7% (5 pts) the leads were placed along the interventricular septum, in 16.7% (2 pts) along the anterior wall of right ventricle and in 41.7% (5 pts) across the centre of the right ventricle. The tip of the lead was positioned in the apex of the right ventricle in 83.4% (10 pts). In the remaining 16.7% (2 pts) the position was not apical — in 1 patient the anterior wall of the right ventricle and in 1 patient the interventricular septum. In the VVI pacing mode the electrode did not lie on the interventricular septum. In contrast to this in 80% of patients (4 pts) having the DDD pacing mode the lead was situated on the interventricular septum on its course downwards to the ventricle. Conclusions: 1) On the level of the leaflets of the tricuspid valve the lead most often was positioned at the level of the anterior leaflet and the anteroseptal commissure. 2) Most patients had an apical localisation of the tip of the lead. 3) Differences between morphological and echocardiographic studies are related to the intravital and the two-dimensional character of echocardiography, and probably to the small population of the group examined.
Rapid regular atrial pacing (RAP) produces changes in atrial function similar to those caused by atrial fibrillation in animal models. Left atrial appendage (LAA) function represents regional atrial function. The aim of our study was to investigate the influence of RAP on left atrial regional function and to evaluate the reversibility of changes after terminationtermination of pacing in a canine model. Eight dogs were subjected to RAP (400 bpm) for 16 days. Transesophageal echocardiography was performed at baseline, immediately after RAP and weeks after the terminationtermination of RAP. The LAA peak late emptying velocity (LAA-E) and filling wave (LAA-f) were measured. LAA-E velocities were significantly reduced and filling wave velocities (LAA-f) were significantly less negative after RAP compared with the baseline values. Four weeks after terminationtermination of pacing, the LAA-E and LAA-f velocities were normal. RAP results in impaired regional atrial systolic and diastolic function. The changes were completely reversible 4 weeks after terminationtermination of pacing. These results suggest that the LAA is mechanically stunned after RAP.
Angiotensin I-converting enzyme (ACE), which plays an important role in blood pressure regulation, and methylenetetrahydrofolate reductase (MTHFR) involved in homocysteine metabolism belong to a large group of polypeptides which may be po­tential risk factors for atherosclerosis and coronary artery disease (CAD). To assess whether polymorphisms of the genes encoding these peptides are associated with CAD in Silesian we conducted a study among 68 individuals suffering from CAD (in­cluding 52 cases after myocardial infarction), 51 subjects with positive family history of CAD and 111 controls. We analysed the distribution of genotypes and allele fre­quencies of the insertion/deletion (I/D) polymorphism in the ACE gene using PCR am­plification, and the C677^T polymorphism in the MTHFR gene using PCR-RFLP analysis. We found that D allele frequency was significantly higher in CAD patients (61%) than in controls (43%) (P = 0.001, OR = 2.06). The D allele carriers (DD + ID geno­types) were more frequent in the CAD patients (85%) compared to control group (65%) (P = 0.003, OR = 3.14), whereas the familial CAD risk group shows the highest frequency of the ID genotype (57% vs 43% in controls). In contrast, the MTHFR polymorphism does not seem to be associated with the disease. Our data indicate that in Silesian CAD patients the disease is strongly associated with carrier-state of the ACE D allele, but not with the C677->T transition in the MTHFR gene.
Background. Following pharmacological recommendations and leading a healthy lifestyle are imperative to improve the health and quality of life of patients with heart failure (HF). Material and methods. This cross-sectional, observational study examined 100 patients with HF who were treated in the cardiology department. The average age of the respondents was 70±14 years (mean±SD), and the majority were men (65%). The Health Behavior Inventory Questionnaire and the authors’ questionnaire were used. Results. The respondents collectively reported an average level of health behaviors. There was a negative correlation between age and proper eating habits (rho=-0.248; p=0.013) and a positive mental attitude (rho=-0.270; p=0.007). Higher or secondary education was associated with increased levels of health behaviors in all categories. Patients with a shorter duration of disease (<15 years) were more likely to take pro-health measures in the categories of proper eating habits (p=0.001) and positive mental attitude (p=0.004). Patients with a higher level of knowledge about the disease demonstrated higher levels of health behaviors. Subjects who had a pacemaker/cardioverter implanted had lower positive mental attitudes (p=0.048). Conclusions. It is important to encourage health behaviors in patients with HF. These actions should be aimed primarily at elderly people, with primary and vocational education, longer disease duration (>15 years), lower knowledge of the disease, and/or an implanted cardioverter/pacemaker.
In animal and human studies, it has been shown that atrial fibrillation shortens the atrial refractory period and impairs its rate adaptation. The objective of this study was to evaluate the effects of high-rate pacing on sinus node function and intra-atrial conduction. Eight dogs were subjected to rapid atrial pacing (AP) at 400 bpm for 16 days. Sinus node recovery time (SNRT) and P-wave duration were measured at baseline, immediately after AP and four weeks after the termination of AP. SNRT immediately after AP was significantly prolonged at all pacing rates compared to the baseline values. P-wave duration was significantly longer after AP relative to the baseline values. All the variables were completely reversible four weeks after the termination of pacing. Rapid AP induces sinus node dysfunction and prolongs the intra-atrial conduction time. It is possible that the electrical remodelling extends to the sinus node as well.
An impact of Helicobacter pylori on the process of atherogenesis may be related to the intensity of humoral response against selected specific antigens of this bacteria. We performed serological studies in which the recognition of 7 selected antigens was possible. The investigated group consisted of 56 patients hospitalized due to unstable angina pectoris. The control group consisted of 29 symptomless volunteers. The levels of class G serum immunoglobulins interacting with glycine extract (GE) of H. pylori antigens were assessed by ELISA test in both groups. The same sera were tested by the Milenia blot H. pylori IgG system. In this assessment the presence of IgG antibodies interacting with antigens of molecular weight of 120, 87, 64, 35, 30, 26, and 20 kDa was estimated separately for every listed antigen. The results revealed significant differences between investigated groups in the prevalence of anti-GE IgG (unstable angina - 100% vs. controls - 60%) and in the level of such antibodies expressed as total optical density units - OD450 (6.1 ±3.0 vs. 3.4 ±3.0 respectively, p<0.05). However, anti-GE IgG detected in the sera of patients as well as controls reacted with similar frequency with selected H.pylori antigens: highly specific (120, 87, 64, 30 kDa) and specific (35, 26, and 20 kDa). We conclude, that although H. pylori infection is so common and mainly associated with gastroduodenal symptoms, it is also recognized by serological methods with high prevalence in patients with coronary artery disease, and less frequently in symptomless individuals. The humoral response against H. pylori in class G immunoglobulins in patients with unstable angina is characterized by higher levels of anti-H. pylori IgG but not by the higher prevalence of serum IgG interactions with the highly specific and specific H. pylori antigens. Such infection could be considered as a cofactor for atherogenesis by inducing strong humoral response against surface antigens of this bacteria.
Equinatoxin II (EqT II) is a pore-forming actinoporin. Its lethality in rat tissue is due to cardio-respiratory effects. The toxin contracts the vascular smooth muscle only in the presence of intact endothelium. In our study, its effects on the endothelial cell culture ECV-304 were tested. The EqT II effects were dose-dependent and were influenced by calcium ions and sucrose. The obtained results support the conclusion that calcium ions are the intracellular messengers of the EqT II effects on the isolated endothelial cells.
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