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Biomedical subjects

Dariusz Michałkiewicz

Publications and source records attributed to Dariusz Michałkiewicz.

12 recordsLinked to original sources
PubMed2006

[Detection of patients at risk for paroxysmal atrial fibrillation (PAF) by signal averaged P wave, standard ECG and echocardiography].

UNLABELLED: The aim of this study was to evaluate whether analysis of signal averaged P wave, together with left atrial diameter (LA) and P wave duration in surface ECG lead II (PII) allow to predict the risk of PAF. MATERIAL AND METHODS: Patients with coronary heart disease and/or hypertension were examined (n=145). They were divided into two groups 110 patients with PAF were compared with 35 patients without PAF Age (60,5 vs. 57,4 years) and LA size (39,8 vs. 3,7 mm) were similar in two groups. RESULTS: The root mean square voltage (RMS) for the last 10,20, 30 ms were calculated and for all of the filtered P wave (RMSW) were measured RMS ratio (RMSR) were calculated according to RMSW/ RMS20. Filtered P wave duration (PWD) and difference befteen PWD and P II (PWD-PII) were established. Most of the analyzed parameters were statistically significant (p<0,05). The statistical analyses made it possible to outline the score index evaluating how PAF reacts parameters. CONCLUSIONS: Score index evaluating of the PAF occurrence and its influence is statistically significant with sensitivity 86%, specificity 83,5% and index positive predictor 82,7% and index negative predictor 83,7%. The most significant parameters which detect the patients with the occurrence of PAF are PWD > or =130ms, RMS20<3, microV, RMS10<2,2 microV and PWD-PII > or =40 ms.

Amiodarone↗
PubMed2006

[The influence of weather conditions on the occurrence of paroxysmal atrial fibrillation].

UNLABELLED: The effect of the changing weather conditions on the incidence of the paroxysmal atrial fibrillation (PAF) has not been documented before. MATERIAL AND METHODS: This analysis retrospectively assessed the influence of the weather conditions on 1153 PAF cases over the period of 10 years. The average age of the studied population was 64.9 +/- 9.2 years. There was 60% males in the group. The majority (84%) had an existing heart disease, the remaining part was diagnosed as the lone PAF. RESULTS: The following factors favoured the FAP occurrence: high air temperature (> 25 Centigrade) for more than 3 days, low temperature (< 8 Centigrade), water vapor pressure > 16.5 kPa, accelerated increase of the air pressure > 8hPa over 2 days. CONCLUSIONS: The following weather conditions such as: temperature, air humidity and pressure have a definite impact on the occurrence of the paroxysmal atrial fibrillation episodes in 87% of patients especially those with co-existing coronary heart disease, hypertension or older age.

Aged↗
PubMed2006

[The influence of myocardial infarction on depression in patients with coronary artery disease].

UNLABELLED: The recent studies revealed the relation between depression and the prevalence of cardio-vascular diseases, as well as their complications. However the correlation between the risk factors of coronary artery disease and depression in patients suffering from cardio-vascular disorders hasn't been sufficiently examined. The history of myocardial infarction (MI) is a well known factor, which increases mortality. The aim of the study was to determine if there was any relation between the history of myocardial infarction and depression rate in patients with cardio-vascular diseases. MATERIAL AND METHODS: The study involved 163 patients, 75 women and 88 men, aged 29 to 86 years (mean age 60.75 +/- 11.01), hospitalised for the purpose of undergoing coronary angiography or percutaneous transluminal coronary angioplasty (PTCA). Before the procedure, the symptoms of depression were evaluated in all the patients. Each of them filled the Beck's scale inquiry-sheet. Two groups of patients were detached: group A consisted of patients with the history of MI (n = 96), group B-of patients with negative history of MI, diabetes who had never undergone PCI, or coronary artery bypass graft (CABG) before (n = 42). The control group (group C) consisted of 75 individuals, aged 20 to 80 (mean age 45 +/- 11.14 y), who felt healthy according to WHO criteria, weren't on any medication, hadn't been hospitalised in previous 5 years (at any reason) and in whom cardio-vascular diseases and their modificable risk factors were excluded. RESULTS: The median of the Beck's score of depression for group A (9 points) was significantly higher (Wilcoxon test), than for group B (6.5 points), p < 0.02 and for the group C (3 points), p < 0.05. (tab. 1). CONCLUSIONS: In patients with cardio-vascular disorders depression is more frequent, than in health individuals. History of MI increases the prevalence of depression.

Adult↗
PubMed2006

[Glycosylated hemoglobin and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus].

UNLABELLED: Glycosylated hemoglobin (HbA1c) is a confirmed prognostic factor of cardiovascular complications in diabetic patients. The relative odds of cardiovascular disease (CD) increase by 20% for 1% increase of HbA1c above HbA1c 5%. The aim of the study was to assess relationship between diastolic dysfunction and HbA1c in patients with diabetes mellitus 2 (DM 2) without critical coronary stenosis in coronarography. MATERIAL AND METHODS: The study comprised 57 subjects (35 men and 22 women) with DM 2, without coronary stenosis in coronarography, with normal and elevated HbA1c levels. The subjects were divided into two groups depending on HbA1c level: with HbA1c < or = 6.1% and HbA1c >6.1%. Parameters of left ventricular diastolic function were assessed in echocardiography according to criterions of European Society of Cardiology. Subjects with decreased systolic function (EF<50%) were excluded from the study. RESULTS: Diastolic dysfunction of the left ventricle was observed in 43% of patients with HbA1c >6.1% comparing to 4.5% of patients in the group with HbA1 < or = 6.1%. In the group with HbA1c >6.1% in 38% of the patients abnormal relaxation in early filling phase and in 5% abnormal isovolumetric relaxation were observed. In the group with HbA1 < or = 6.1% in only 1 patient (4.5%) abnormal relaxation in early filling phase was observed. CONCLUSION: Diastolic function of the left ventricle in patients with diabetes is dependent on HbA1c levels.

Aged↗
PubMed2006

[The effects of amiodaron on the thyroid function].

The use of several groups of medications may result in thyroid dysfunction including thyrotoxicosis or hypothyroidism of various degree (from subclinical to full-clinical syndrome). The mentioned disturbances may develop either on the basis of normal euthyroid gland or may overlap the previously-existing oceult changes (first of all different forms of autoimmune thyroiditis). Amiodarone is a widely used anti-arrythmic drug with considerable potential to cause thyroid dysfunction because of its 35% iodine content. Besides amiodarone particles are known to inhibit T4 to T3 conversion, they work as inhibitors of nuclear receptors for thyroid hormones, exert cytotoxic effect and induce immune/inflammatory process in thyroid gland. Both thyrotoxicosis (AIT - amiodarone induced thyrotoxicosis) and hypothyroidism (AIH - amiodarone induce hypothyroidism) may develop during amiodarone therapy. AIT appears to occur more frequently in geographical areas with low iodine intake, whereas AIH is more frequent in iodine-sufficient areas. Two forms of AIT are known. Their differentiation is very important for further therapeutical procedures. Because thyrotoxicosis and hypothyroidism symptoms during amiodarone therapy are scanty, there is need for periodic determination of thyroid function. Normal ranges for amiodarone patients differ from those for the rest of population. They are presented in this review. Treatment of AIT is very complicated. Sometimes there is need to use few methods together, especially when amiodarone treatment can not be stopped.

Amiodarone↗
PubMed2006

[Positive microvolt T-wave alternans as a marker of ventricular arrhythmia trigering during cardioverter-defibrillator implantation].

Microvolt T-wave alternans (MTWA) is promising method for noninvasive assessment of arrhythmic risk, but its role hasn't established yet. The aim of this study was to establish the MTWA potency to predict the ventricular arrhythmia triggering during implantable cordioverter-defibrillator (ICD) implantation. Material and metods. The study group consisted of 21 patients, aged 63.0+/-8.0 years; EF was 38.0+/-12.8%. Seventeen of them had a history of myocardial infarction and 4 had non-ischemic cardiomyopathy. The reason for ICD implantation were secondary prevention due to nonfatal cardiac arrest caused by VF/VT in nineteen patients and in two patients ICD was implanted because of unexplained syncope and low EF (< or =35%). All patients underwent VT/VF triggering during device implantation caused by electrophysiological study (EPS). If this proved ineffective aggressive protocol of 50 Hz BURST and T SHOCK was applied. After ICD implantation the following tests were performed: ECG with HR, QRS and QTc evaluation, 24-hour ECG Holter monitoring with HRV assessment and MTWA evaluation during treadmill exercise test. Results. In the group with VT/VF induced by less aggressive protocol (EPS), group I (n = 10) MTWA was present in nine patients, in one the result of MTWA was indeterminate. In the group with VT/VF induced by more aggressive protocol, group II (n = 11) MTWA was present in four patients, indeterminate in four and absent in three. There was a significant (p = 0.017) difference between group I and II in the frequency of positive result of MTWA. There were no differences between the two groups according to time domain parameters of HRV such as SDNN, RMSSD and PNN50 and QTc. There was a significant difference between the two groups in time duration of QRS complexes, 118.9+/-14.7 vs. 105.6+/-11.5 accordingly (p < 0.04). Conclusions. MTWA may help identify patients in whom VTNVF is more easily inducible by electrophysiologic study during ICD implantation. It is easier to induce ventricular arrhythmia when QRS complexes are wider, irrelevant to left ventricular dysfunction and autonomic function of the heart.

Aged↗
PubMed2006

[Right ventricle pacing site optimization guided by intracardiac echocardiography].

UNLABELLED: Right ventricle outflow tract (RVOT) is an alternative pacing site to right ventricle apex (RVA). Intracardiac echocardiography (ICE) is a new method for intracardiac structures visualization. THE AIM: is comparison of functional effects of DDD permanent ventricular pacing in patients with lead implanted in RVA or in RVOT with the use of traditional fluoroscopy or in RVOT guided by ICE. MATERIAL AND METHODS: 33 patients with AV block grade I/III no older than 75 y (mean age 65,9+/-0,3 years). Group 1: 10 patients with RVA lead implantation. Group II: 12 patients with leads implanted in RVOT with the use of ICE. Group IlI: 11 patients with lead positioned in RVOT with the use of fluoroscopy. High septum was established as an target pacing site for RVOT implantation. On 3 day and 3 months after implantation the following parameters were collected: VO2 max, 6-minute walking test distance, level of NT-proBNP. The comparison of relative changes was done, 3 month vs. 3 day for each parameter. RESULTS: Statistically significant greater decrease in NT-proBNP was found in Group II in comparison with both Group I and Ill (respectively p = 0.021 and p _ 0.034). Significantly greater increase in VO2 max was detected in patients Group II comparing to Group I (p = 0.047). Moreover it was found that ICE guided implantation is most effective in precise lead positioning. CONCLUSION: ICE guided lead localization on high interventricular septum seems to have better functional characteristics than other right ventricle pacing sites.

Aged↗
PubMed2006

[Drugs affecting thyroid--part II].

The use of several groups of medications may result in thyroid dysfunction. So far the best known medication is amiodarone. The role of other medications and diagnostic agents in causing thyroid dysfunction is quite often forgotten. We presented medications and diagnostic agents commonly used in medical day-to-day practice. We described other than amiodarone iodinated agents and quoted recently published European guidelines in using iodinate contrast agents. We focused on lithium and psychiatric drugs and mechanism of their toxic impact on thyroid gland. These agents are important as they are applied for years (including children). At the end the impact of cytokines on thyroid gland was discussed, medications ever more widely applied in anti-viral and anti-neoplastic therapy.

Amiodarone↗
PubMed2005

[Degenerative valvular and left ventricle structural changes in echocardiography in patients with rheumatoid arthritis].

UNLABELLED: The disproportion between absence of clinical manifestations of circulatory system involvement and serious lesions in the heart found on post mortem examinations, more frequently diagnosed congestive circulatory failure and also higher mortality rate of patients with rheumatoid arthritis (RA), encouraged the authors to study the subject. THE AIM OF THE STUDY: Echocardiographic assessment of the effect of rheumatoid process on the heart in patients with RA without clinically overt features of heart disease. MATERIAL AND METHODS: The study was conducted in 50 patients with RA diagnosed on the basis of the American College of Rheumatology (ACR) criteria and in 50 persons matched with the patients with respect to age, gender, body area and body mass index, heart rate and arterial pressure. Persons with manifestations and/or history of cardiovascular diseases were excluded from the study. RESULTS AND CONCLUSION: The authors found that: in rheumatoid arthritis, the involvement of the heart by the pathological process is manifested as degenerative changes of valve leaflets, and these lesions correlate with interventricular septum thickness and the mass and mass index of the left ventricle.

Aged↗
PubMed2002

Autonomic nervous system and left ventricular hypertrophy in essential hypertension.

BACKGROUND: Patients with essential hypertension (EH) and left ventricular hypertrophy (LVH) have an increased risk of cardio-vascular complications. Alterations in the autonomic nervous system (ANS) activity may play a role in the development of serious cardiac arrhythmias and mortality in these patients. AIM: To examine the activity of ANS in patients with established EH in relation to the presence of LVH. METHODS: The study group consisted of 70 subjects: 50 patients with untreated EH (mean age 44.4+/-12.7 years, 28 patients without LVH and 22 with LVH), and 20 age-matched healthy volunteers. ANS reactivity was assessed using heart rate variability (HRV) analysed during tilt table testing at 60 degrees. The following 5-min time-periods were analysed: (A) before tilting (supine position), (B) initial period of tilting, (C) last 5 min of tilting, and (D) immediately after completion of tilt test (after return to supine position). RESULTS: Patients with EH without LVH had a higher increase of LF/HF values (period B versus period C) compared with controls (p<0.05). The change from tilt to supine position caused significantly lower change in lnHF values in patients with EH and LVH than in controls (p<0.01) or patients with EH without LVH (p<0.005). In patients with EH and LVH a significant correlation between HF and LVmass/height (r=-0.5, p<0.01) was noted. Compared with healthy controls, patients with EH and LVH had significantly lower HRV parameters [lnLF values were significantly lower in all analysed periods, (p<0.05), and lnHF - during period D, (p<0.01)] whereas LF/HF ratio assessed during period D was significantly higher (p<0.05). CONCLUSIONS: In patients with EH without LVH a relative dominance of sympathetic activity is present. LVH in EH leads to a decrease in vagal drive and progressive inhibition of parasympathetic activity, both of which decrease HRV. These changes may play an important role in the electrical instability of hypertrophied myocardium.

Journal Article↗