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Biomedical subjects

J Korewicki

Publications and source records attributed to J Korewicki.

At least 37 records · Page 2Linked to original sources
PubMed1993

Influence of isosorbide dinitrate (ISDN) on compliance of the pulmonary venous system.

Irreversible poor pulmonary venous compliance can worsen the natural course of patients with high pulmonary capillary wedge pressure, especially those with mitral stenosis, but nitrates (isosorbide dinitrate--ISDN), which have venodilatory properties, could increase this compliance in most patients. The aim of this study was to assess the hemodynamic effects of ISDN in patients with mitral stenosis, with special emphasis on the pulmonary venous compliance. Pulmonary venous compliance was estimated according to the Hirakawa equation (dV/dp = 0.4 x k2 x sV/(v-d)) in 39 patients with mitral stenosis during preoperative right heart catheterization with Vygon 5155-180 thermodilution catheters at rest and during exercise (25 W) in the supine position. This procedure was repeated after the application of 3.75 mg of Iso-Mack spray. Overall, ISDN increased pulmonary venous compliance significantly both at rest and during exercise (6.0 to 7.5 ml/mmHg and 6.0 to 7.6 ml/mmHg, respectively). The patients were divided into two groups according to their level of ISDN response; those with a good response of an increase of 15% or more in pulmonary venous compliance (Group I), and those with an increase of less than 15% (Group II). There were significant differences between these two groups in stroke volume index and heart rate. In Group I, while the mean right atrial pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure all decreased significantly, there was a simultaneous insignificant decrease in the stroke volume index and an also insignificant increase in the heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Function, Right↗
PubMed1993

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement].

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

Adult↗
PubMed1993

[Hemodynamic effects of one administration of l-dopa in patients with left ventricular heart failure (introductory remarks)].

The study group consisted of 8 men with congestive heart failure. They ranged in age from 33 do 63 years (mean 48). Three patients were in class III NYHA, five in class IV. Idiopathic cardiomyopathy was diagnosed in 6 patients, one individual displayed ischemic heart disease and one patient was after mitral and aortic-valve replacement despite a normally functioning prosthetic valve. L-dopa was given orally beginning with 250 mg every six hours until a total daily dose of 4.0 g was achieved with no side effects (patients additionally received 50 mg of pyridoxine hydrochloride). Afterwards L-dopa was withheld for 24-36 hours. Having completed this washout period, patients underwent right heart catheterization, with placement of a balloon-tipped thermodilution catheter in a pulmonary artery, so that balloon inflation allowed recording of the pulmonary capillary wedge pressure. Right atrial and pulmonary arterial pressures were monitored continuously. Systemic arterial pressure was measured by mercury manometer. Cardiac output was determined by the thermodilution technique. Rest and effort hemodynamic measurements were repeated before and one, three hours after administration of 1-dopa. The base-line hemodynamic values were consistent with the clinical presentation of severe congestive heart failure. The average cardiac index (CI-1/min/m2--rest--1.93; 25 Watt-3.1) and stroke volume index (SVI-m1/m2--rest--22.2; 25 Watt-32.0) were markedly lowered. Left ventricular filling pressure and pulmonary artery pressure were elevated. The systemic vascular resistance was significantly increased (SVR -j.W.--rest--22.7; 25 Watt-14.2). Administration of 1-dopa resulted in the increase in cardiac index and stroke volume index accompanied by a substantial reduction in systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Factors influencing survival in patients with coronary disease. I. Characteristics of examined patients and survival curves].

The group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. The number of patients with a poor left ventricular function was high in the group treated surgically and non surgically. Ejection fraction < 50% was found in 27% and 43% respectively, LVEDP > 12 mmHg (66% and 69%), EDVI > 100 ml/m2 (58% and 70%). Survival curves were calculated in the two different subsets of patients treated surgically and non surgically. Despite some favorite trend toward a better outcome for patients treated surgically the differences were not statistically significant for a whole group. However we showed a significantly higher probability of survival in the subgroup of the three vessel disease treated surgically compared to other treatment. There were no significant differences in survival in patients with one, two, or three vessel disease treated surgically (survival probability of 0.82; 0.78; 0.84 respectively after 7 years). In patients treated non surgically the growing number of diseased vessels worsened the prognosis (survival probability of 0.84; 0.78; 056 respectively). In our observation the differences for better outcome in patients with poor left ventricular function treated surgically did not reach a statistical significance.

Coronary Angiography↗
PubMed1993

[Factors influencing survival in patients with coronary heart disease. II. Multivariate logistic function analysis].

A group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. Two hundred ninety of them were treated surgically, 393 non surgically. A multivariate logistic function (MLF) analysis of 10 variables is presented obtained from anamnesis and hemodynamic data and their significance upon survival after 2, 4 and 6 years. In the group treated non surgically the number of narrowed vessels was a factor independently significant after 2, 4 and 6 years. After 4 and 6 years the ejection fraction and the left ventricle end diastolic volume index were also significant. In the group treated surgically none of those were significant after 2 years. After 4 and 6 years anamnesis of arterial hypertonia was significant after 6 years also left ventricle end diastolic volume index. Coefficients calculated from multivariate logistic function analysis allow the calculation of probability of survival for an individual patient.

Adult↗
PubMed1992

[Analysis of remission of pulmonary hypertension after mitral valve replacement].

In a group of 32 patients with mitral valve disease and extreme pulmonary hypertension, the efficacy of mitral valve replacement (MVR) was analysed. In all patients hemodynamic and clinical data were obtained and compared before and after operation. After surgery a statistically significant differences (p < 0.01) of the pressure was observed in right atrium and ventricle, pulmonary artery and capillaries, the pulmonary resistance was decreased, the cardiac index was increased. The improvement of hemodynamic parameters correlated well with clinical data. But it has not influenced for return to the job.

Adult↗
PubMed1991

[Causes of occurrence of wave V of pulmonary wedge pressure in patients with acquired heart valve diseases].

It is believed that a significant V wave in pulmonary capillary wedge pressure (PWP) is a sign of mitral regurgitation. Of 358 patients with acquired valvular heart disease in 24-cases a significant V wave (15 mm Hg of PWP) was recorded during right heart catheterization. All patients underwent right heart catheterization with a flow- directed, balloon-tipped, thermodilution catheters (Edwards Labs). Mean pulmonary, capillary wedge, and right atrial pressures were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. After measurements of flow, pulmonary and systemic resistance morphology of V wave from PWP recordings was assessed. We measured dp/dt of the ascending limb of V wave and Libanoff and Rodbard V wave index (dp/dt:CI). Nine patients with significant V wave had no signs of mitral regurgitation and had mainly significant mitral stenosis (group III). Group II (6 patients) consisted of patients with different combinations of acquired left heart valve disease and mitral regurgitation. Group I (9 pts) consisted of patients with isolated mitral regurgitation. There were no differences in right atrial, pulmonary, and capillary wedge pressures, cardiac index, pulmonary and systemic valvular resistance among groups I, II and III. There were significant differences as far as dp/dt V wave was concerned (gr I--136 +/- 31.4, gr II--112.2 +/- 30.7, gr III--72.7 +/- 31.2 mm Hg/s). Libanoff's index of V wave was also significantly different in all three groups--gr I--12.7 +/- 6.2; gr II--8.0 +/- 2.3; gr III--4.8 +/- 1.7 mm Hg/s). It seems that V wave in PWP recordings is not only a sign of mitral regurgitation, but also could be a sign of decreased pulmonary veins compliance.

Aortic Valve Insufficiency↗
PubMed1990

[Effect of intravenous administration of nitroglycerin and regitine on hemodynamics in mitral valve insufficiency].

During exercise in subjects with congestive heart failure and mitral regurgitation the rise in systemic arterial pressure is usually accompanied by increase in systemic vascular resistance. That could cause decrease of cardiac output not only because of a lack of myocardial reserve, but also because of an increase of mitral regurgitant volume. In such situation decrease in left ventricular preload could further increase the regurgitant volume and cardiac output. Whether changes in pre-or afterload can cause significant changes in mitral regurgitation, nitroglycerin and phentolamine was assessed in that group of patients. 22 patients with significant mitral regurgitation (3+,4+) was randomly divided into two groups. The first one received short intravenous infusion of nitroglycerin at a rate of 170 micrograms/min. The second one received phentolamine intravenously 1-1,5 mg/min. Patients underwent right heart catheterization with Swan-Ganz thermodilution catheter. Mean pulmonary, pulmonary capillary wedge, and right atrial pressure were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. If there were no contraindications (PWP greater than 30 mm Hg) an effort test was performed (cycloergometer, supine position). The same protocol was repeated during administration of nitroglycerin and phentolamine. Nitroglycerin significantly decreased right atrial and capillary wedge pressure (from 22.9 to 15.6 mm Hg). There were no significant differences in cardiac output, pulmonary and systemic vascular resistance. Pulmonary artery pressure decreased after nitroglycerin but the difference was not significant. All above effects of nitroglycerin persisted during effort. Phentolamine decreased significantly right atrial, pulmonary and capillary wedge pressure with simultaneous increase of cardiac output (30%) and decrease of pulmonary and systemic vascular resistance. In summary, nitroglycerin decreases only symptoms and theoretically could worsen forward flow in patients with mitral regurgitation and heart failure, especially in subjects with a significant increase of systemic vascular resistance during effort.

Adult↗
PubMed1988

The correlation between CK MB curve type and the clinical course of recent myocardial infarction.

In 265 patients with acute myocardial infarction (MI) for whom the 72-hour CK MB curve was obtained, three types of a curve were found: with a single and early 16 h peak value (type A), with a single late 16 h peak value (type B), and with a double peak (type C). Type A of the CK MB curve was found in 32% of patients with acute MI, type B in 55% and type C in 13%. There were no significant differences of CK MB max between the type groups. Infarct size differed significantly between groups (A-29 +/- 19, B-35 +/- 22, C-53 +/- 30 g Eq CK MB). In-hospital mortality also differed significantly particularly between type C (31%) and type A groups (5%). Nitroglycerin or practolol given intravenously during the first 48 hours changed the CK MB curve mainly by decreasing CK MB max as compared to controls treated conventionally. There was no effect of treatment with either nitroglycerin or practolol on the clinical course in patients with type A CK MB curve. There is a good correlation between the CK MB curve type and the clinical course of MI. Nitroglycerin or practolol decreased the infarct size only in patients with either B or C type of CK MB curve, having no influence in patients with a mild form of acute MI (type A).

Adult↗
PubMed1987

Significance of anterior precordial ST-segment depression in acute inferior myocardial infarction.

In 70 consecutive patients (pts) with acute transmural inferior infarction, 58 had significant precordial ST depression (group A) and the remaining 12 had no ECG changes in precordial leads (group B) on admission. At the time of hospital discharge, the persistence of anterior ST depression was observed in 13 pts (group A1), normalization in 45 (group A2). Infarct size was significantly greater (p less than 0.05) in group A than in group B (37.6 vs. 23.8 CK-MB gEq). The largest infarct (51.5 CK-MB gEq) and the most serious clinical course was observed in group A1. No significant differences were noticed in the frequency of reinfarction and episodes of acute coronary insufficiency during hospitalization and one-year follow-up between groups. Persistent precordial ST depression is a simple ECG marker of extensive infarction, left ventricular dysfunction and a worse clinical course.

Acute Disease↗
PubMed1986

The effect of infarct size on atrioventricular and intraventricular conduction disturbances in acute myocardial infarction.

The effect of infarct size estimated from serial CK-MB isoenzyme determinations on the incidence of atrioventricular and intraventricular conduction disturbances was examined in 250 patients suffering their first myocardial infarction. The size of the infarct was significantly greater (P less than 0.001) in 72 patients with conduction disturbances than in 178 without conduction defects (54 +/- 29 vs. 35 +/- 22 CK-MB gEq). The largest size was observed in 10 patients with bifascicular block (71 +/- 38 CK-MB gEq). Within the group of patients with intraventricular conduction disturbances, the size of the infarct was significantly greater (P less than 0.01) when localized inferiorly rather than anteriorly (91 +/- 10 vs. 58 +/- 27 CK-MB gEq). The size in those patients with complete atrioventricular block and anterior infarction was larger than in those with an inferior lesion (76 +/- 21 vs. 52 +/- 33 CK-MB gEq). The size in those patients with inferior infarction and complete block was significantly greater (P less than 0.05) than in patients with similarly positioned infarction without conduction disturbances (52 +/- 33 vs. 35 +/- 22 CK-MB gEq). There was no significant difference in the size of infarct when inferior infarction was complicated by first- and second-degree block in comparison to those without conduction defects (38 +/- 23 vs. 35 +/- 22 CK-MB gEq). A correlation was observed between the size of infarction and the incidence of conduction disturbances (P less than 0.001); the greater the size the higher the incidence of conduction disturbances.

Adult↗
PubMed1985

Haemodynamic effects of nitroglycerin infusion in patients with postinfarction heart failure.

On the basis of their own 5-year experience, the authors discuss the indications for, and limitations of, intravenous infusion of nitroglycerin (NTG). In 42 patients with postinfarction heart failure, NTG produced a significant reduction of left ventricular filling pressure, regardless of its initial value. In patients with normal or only slightly elevated left ventricular filling pressure, NTG caused a decrease in cardiac index and mean arterial pressure as well as, in the earliest phase of infusion, an increase in peripheral resistance. Similar trends were observed also in patients with markedly elevated left ventricular filling pressure if mean arterial blood pressure fell by more than 20%. Taking into consideration that the range of the effective doses was very wide (15-150 micrograms/min), the authors believe that intravenous NTG infusion is indicated mainly in cases of manifest heart failure and should be administered under strict control of the dosage and with careful monitoring of the therapeutic effects.

Adult↗