PubMed Health⌕ Search

Biomedical subjects

Marian Cholewa

Publications and source records attributed to Marian Cholewa.

At least 19 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

[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↗
PubMed2005

Prognostic value of head-up tilt test with intravenous beta-blocker administration in assessing the efficacy of therapy in patients with vasovagal syncope.

BACKGROUND: Although beta-blockers are frequently used in order to prevent the recurrence of vasovagal syncope, the efficacy of this treatment is difficult to determine. OBJECTIVES: To determine if the result of a tilt test with an intravenously administered beta-blocker can predict the long-term efficacy of beta-blockade. METHODS: The study group consisted of 62 patients (29 females, mean age 32.8 +/- 12.3 years and 33 males, mean age 35.9 +/- 18.2 years) with at least two syncopal episodes during 6 months preceding the positive tilt test. After the baseline tilt test, propranolol (0.1 mg/kg BW) was administered intravenously and the tilt test was repeated. Beta-blockade was considered effective if the subsequent tilt test proved negative (complete efficacy) or if the time until the occurrence of syncope at the subsequent tilt test was longer compared to the baseline test (partial efficacy). All the patients were put on continuous propranolol treatment and were followed up for a period of 1 year or until the time when syncope recurred. RESULTS: Intravenously administered propranolol prevented (n = 33) or delayed (n = 18) the occurrence of syncope at the tilt test in 51 patients (82%), while it was found ineffective in the remaining 11 patients (18%). During the 8.6 +/- 6.7 months (range 1-14) of the follow-up period, the syncope recurred in 20 patients (32%), with 13 patients (25%) in the group where intravenously administered propranolol proved effective versus 7 patients (64%) for whom intravenously administered propranolol did not prevent syncope during the tilt test (P < 0.015). The survival analysis with respect to the recurrence of syncope revealed a significant correlation between the results of the tilt test with intravenously administered propranolol and the efficacy of the long-term beta-blocker therapy (P < 0.003). There were no significant differences with respect to the predictive value of the tilt test with propranolol between the patients showing complete and partial propranolol efficacy (ns), while significant differences were observed between these two groups on one hand and the patients in whom intravenously administered propranolol was found ineffective on the other (P < 0.04 and P < 0.002, respectively). CONCLUSIONS: Intravenous propranolol prevents tilt-induced syncope in a significant percentage of patients. The results of the tilt tests combined with the administration of propranolol predict the efficacy of a continuous propranolol treatment. Both complete and partial propranolol efficacy at tilt test can successfully identify those patients who will benefit from continuous beta blockade.

Adrenergic beta-Antagonists↗
PubMed2005

[Clinical and angiographic correlates of coronary calcium scoring in multislice computed tomography (MSCT)].

BACKGROUND: The MSCT calcium scoring allows to identify patients with increased coronary event risk or at early stages of coronary artery disease (CAD). AIM: The aim of the study was to find the correlation of calcium score with various clinical features and degree of coronary stenosis. METHODS: 40 consecutive patients (10 women) with angiographically proven coronary artery disease were assessed for coronary calcium score by means of MSCT not later than 48 hours after the angiography. The acquisition parameters were as follows: 3.2 mm slice thickness, 1.6 mm increment, pitch 1.25, 120 kV, 200 mAs, rotation time of 500 ms, supine patients during single breath-hold. The calcium score was semiautomatically calculated taking into account the size and density higher than 130 Hounsfield units. The clinical features such as the presence of hypertension, diabetes, dyslipidaemia, obesity (body mass index), smoking, CCS angina score, previous myocardial infarction, CAD duration, degree of stenosis and diffused disease were also analysed by means of Spearman's test. RESULTS: The calcium score in the left anterior descending artery (LAD) 271 + 598 showed good correlation with the degree of stenosis in the LAD 69 +/- 37 (r = 0.591, p<0.0001) and angina score (median 2, p<0.001). It was also correlated as well as calcium score in the LMA 55 +/- 147 with the CAD duration of 9 +/- 9 years and diabetes (p<0.01). The CS in the RCA 102 +/- 362 was associated with the diabetes, dyslipidaemia and obesity with the p<0.03. The score in the LCX 282 +/- 797 was correlated with the degree of stenosis in every artery (p<0.001 for the LCX = 56 +/- 39). The total calcium score 675 +/- 1462 was associated with the angina score, CAD duration (p<0.001), diffused disease and the stenosis in the LAD and LCX (p<0.0001). CONCLUSION: The total and the LAD coronary calcium score may be associated with the severity of symptoms, degree of stenosis in the LAD and disease extent. The calcium deposits in the RCA may be more frequent in patients with metabolic disorders.

Adult↗
PubMed2005

Effects of therapy based on tilt testing results on the long-term outcome in patients with syncope.

BACKGROUND: The use of tilt testing (TT) in guiding therapy in patients with syncope remains controversial. AIM: To assess the long-term effectiveness of TT-based therapy in patients with syncope of unknown origin. METHODS: The study group consisted of 340 patients (182 females, mean age 38.2+/-16.5 years, range 15-78 years) with at least two syncopal episodes during 6 months preceding the study. TT was performed at 60 degrees angle for 20 min, followed by sublingual nitroglycerine (NTG) challenge (250 microg) when necessary. After positive baseline TT and returning to supine position, 0.1 mg/kg of propranolol was intravenously administered and a second TT was performed. All patients with positive TT were advised to take propranolol, midodrine or fludrocortisone for 6 months -- the choice of agent was based on standard criteria. The time to first syncope was an indicator of the efficacy of treatment and a recurrence of syncope was the end-point of the study. In patients who did not faint during follow-up, the last date of contact was taken as the end of observation period. RESULTS: Out of 340 patients who underwent TT, 148 with positive TT and propranolol challenge were included in the study; 82 patients (group I) received long-term therapy whereas 66 did not (group II). During a 12.8+/-0.9 month follow-up, syncope recurred in 86 patients - 40 (49%) from group I and 46 (70%) from group II (p<0.01). Survival analysis showed that medical therapy was associated with a significant reduction of the risk of syncope recurrence (RRR: 36%, 95% CI: 23-47). The greatest benefit from long-term treatment was documented in patients taking propranolol (RRR: 42%; 95% CI: 18-58; p<0.008), particularly in those in whom intravenous propranolol prevented TT-induced syncope (RRR: 50%; 95% CI: 23-67; p<0.012). Risk reduction in patients treated with midodrine or fludrocortisone was moderate (RRR: 22%; 95% CI: 11-34; p>0.09). CONCLUSIONS: Carefully selected and TT-based long-term pharmacological treatment is associated with a 36% risk reduction of syncope recurrences in patients with syncope of unknown origin.

Adolescent↗
PubMed2005

[Left ventricular function in gated single photon emission computed tomography (GSPET) in patients with myocardial infarction subjected to thrombolysis or primary PTCA].

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) is increasingly common method of treatment patients with acute myocardial infarction. The aim of the study was to assess the left ventricular function in patients with myocardial infarction subjected to thrombolysis or primary PTCA. Gated Single Photon Emission Computed Tomography was performed in 40 patients 6 months after myocardial infarction treated either with thrombolysis or primary PTCA. Left ventricular ejection fraction (LVEF), left ventricular enddiastolic (LVED) and systolic (LVES) volumes were analysed both at rest and after stress. Six months after myocardial infarction LVEF was significantly greater and LVED, LVES volumes smaller in patients treated with primary PTCA in comparison to patients treated with thrombolysis. The above observation suggests that patients subjected to primary PTCA might have better functional outcome in comparison to matched patients treated with thrombolysis after 6 months post myocardial infarction.

Adult↗
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↗
PubMed2005

Haemodynamic indices of the early phase of the tilt test: does measurement predict outcome?

INTRODUCTION: Tilt testing (TT) is a well-established tool in the diagnosis of syncope. However, it is time-consuming. Therefore, identification of parameters that could shorten the duration of TT is desirable. AIM: To identify and assess the usefulness of early haemodynamic parameter changes in prediction of the tilt test results in a group of patients with syncope of unknown aetiology. METHODS: The study involved a group of 105 patients, including 61 women and 44 men, with a mean age of 34.2+/-13.7 (from 13 to 82) years, with at least two episodes of syncope in the last 6 months. The head-up tilt test was carried out according to protocol 60/20 min and if necessary was continued after administration of sublingual nitroglycerine in a dose of 250 g. The assessment of haemodynamic indices was performed employing the beat-to-beat method using the Portapres M2 device. Systolic (SBP) and diastolic (DBP) arterial pressure, heart rate (HR), cardiac output (CO) and stroke volume (SV), and total peripheral vascular resistance (TPR) were analysed. The measured values of haemodynamic indices were calculated by means of averaging 10-second intervals within 3-minute studied periods either before or after tilting a patient. Mean baroreceptor sensitivity (BRS) for the same 3-minute-long intervals was evaluated using the xBRS (cross-correlation) method. In the analysis, differences (Rx) of the haemodynamic values between the beginning of tilting a patient and the rest period were also calculated. RESULTS: Loss of consciousness was noted in 47 (46%) of the studied patients - group I. The remaining subjects (58 patients, 54%) did not develop syncope during TT (group II). The univariate and multivariate logistic analyses of regression revealed that the mean vascular resistance difference (meanRTPR) <-10 dyn.s/cm8 was an independent risk factor of syncope (chi2=3.4; p<0.0008). The presence of this risk factor was associated with a significantly higher risk of a positive response during the tilt test (65% vs 39%; RR: 1.7, 95% CI: 1.2-3.2). In predicting a positive TT result, sensitivity of this parameter was 65%, specificity was 61% and the prognostic value of the positive and negative result was 32% and 86%, respectively. CONCLUSIONS: In patients with syncope of unknown origin, an early (within first 3 minutes of TT) asymptomatic fall in total peripheral vascular resistance is a significant predictor of a positive final result of the test.

Adolescent↗
PubMed2004

[Genes and cardiovascular diseases].

In recent years there has been observed a relatively fast progress of explaining genetic mechanisms of development of many cardiovascular system diseases, mainly diseases conditioned by the mutation of single genes. The situation is different when analyzing the dependencies of complex cardiovascular system diseases whose development has many stages depending on exogenous or hereditary factors. The development of those diseases is due to interactions between particular environmental factors, individual differences in response to environmental factors and often complex genetic relations. The complexity of etiopathogenesis and clinical differentiation are the result of superposition of the effects of the action of single genes responsible for the development, predisposing and/or modulating the course. The analysis of genetic causes of cardiovascular system diseases is made on the basis of models and multigene polymorphisms.

Cardiovascular Diseases↗
PubMed2004

[Estimation of autonomic nervous system tension in patients with syncope of unknown origin--traps in clinical interpretation results of heart rate variability].

UNLABELLED: Voluntary character of a choice of statistical methods weakens the reliability of the results of heart rate variability assessment and based on them clinical conclusions. The aim of the study was to estimate reliability of the chosen statistical methods of analysing changes in spectral components during tilt testing (TT). MATERIAL AND METHODS: 62 patients (34 women), the average age 38.8 +/- 12.8 years, with at least 2 syncopes during the last 6 months that had not been diagnosed by other examinations, were enrolled. The control group consisted of 44 age- and sex-matched volunteers (21 women), the average age 37.4 +/- 12.6 years, who had no history of syncope. All subjects underwent tilt testing according to Westminster protocol. If the result of a passive phase was negative, 0.25 mg nitroglycerine was applied sublingually and the examination was continued for the next 20 minutes. The type of syncopal reaction was defined according to VASIS classification (the vasovagal syncope international study). The evaluation of heart rate variability was based on the frequency domain methods. The low frequency (LF), the high frequency (HF) component and the balance (the LF/HF ratio) were estimated. The response of the autonomic nervous system (AUN) to tilting was evaluated by tests comparing mean values of respective components (the quantitative analysis) and by the modulation index (deltaXFm) reflecting, in percentage terms, changes in analyzed variable values. Taking into account the obtained results there was also a qualitative analysis performed. This analysis referred to the modulation index, which reflected increase or decrease in spectral component value. RESULTS: Tilt testing explained vasovagal origin of syncope in 35 (60%) patients with syncope. Patients were divided into 3 groups according to anamnesis data and results of tilt testing. Group I consisted of 42 healthy volunteers who had negative result of TT Group II--35 patients with history of syncopes and positive result of TT, and Group III--23 patients with history of syncopes and negative result of TT. In all study groups the quantitative analysis revealed the decrease in the LF and HF component values, whereas the evaluation of autonomic nervous system reactivity based on deltaXFm showed the increase in LF power, concomitant with strongly marked, nearly uniform decrease in HF power in Group I and II. The results obtained from the qualitative analysis did not reveal statistically significant differences between study groups in distribution of defined types of autonomic nervous system reactions. CONCLUSIONS: 1. The quantitative analysis has limited credibility in clinical interpretation of changes in autonomic nervous system activity (especially in the low frequency component--LF) occurring during tilt testing. 2. The best estimation of autonomic nervous system activity during tilt testing is assured by the modulation index supplemented by the preliminary selection of data, i.e., rejection of extreme values or those rarely occurring qualitative changes in spectral components.

Adolescent↗
PubMed2003

The direct mapping of the uptake of platinum anticancer agents in individual human ovarian adenocarcinoma cells using a hard X-ray microprobe.

Uptake of platinum-based anticancer compounds into individual human ovarian andenocarcinoma cells was measured using an X-ray microprobe. The uptake of cisplatin, a platinum-based compound, in drug-resistant cells is decreased by approximately 50% after 24 h, compared with the uptake of the drug in nonresistant cells over the same time period. The Pt103 derivative of the drug, in contrast, showed an increased uptake by an order of magnitude in resistant cells over the same time period. Increased uptake appears to allow Pt103 to overcome the resistance mechanism developed by the cell. This work additionally shows that the X-ray microprobe is able to directly quantify Pt drug uptake on a subcellular level and can measure the mass of Pt down to a detectable limit of 20 attograms of Pt (2 x 10(-17) grams or 6 x 10(4) Pt atoms) in 1 s. Such exquisite elemental sensitivity combined with high spatial resolution paves the way for quantitative submicron three-dimensional mapping of elemental distributions within individual cells.

Adenocarcinoma↗
PubMed2003

[Left ventricular function in rheumatoid arthritis patients].

BACKGROUND: The disproportion between the 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 WAS: Echocardiographic assessment of the effect of rheumatoid process on left ventricular structure, and systolic and diastolic function in patients with RA without clinically overt features of heart disease. METHODS: The study was conducted in 50 patients with RA diagnosed on the basis of the 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: The authors found that: in RA, the involvement of the myocardium by the pathological process was manifested as increased wall thickness, increased mass and mass index of the left ventricle with impairment of its diastolic function and normal systolic function. With progressing rheumatoid process, left ventricular systolic function impairment was observed. Left ventricular diastolic dysfunction in the course of rheumatoid arthritis usually was not manifested clinically.

Arthritis, Rheumatoid↗
PubMed2003

Value of propranolol-induced heart rate and blood pressure changes in predicting results of tilt testing.

BACKGROUND: A degree of reduction of heart rate (HR) and blood pressure (BP) values following beta-blocker administration has been shown to indicate beta-blockade effectiveness. Whether this parameter is also useful in the identification of patients with vaso-vagal syncope (VVS) who could benefit from beta-blocker therapy, has not yet been established. AIM: To analyse the usefulness of propranolol-induced acute changes in HR and BP in the prediction of the results of tilt testing (TT) in patients with VVS. METHODS: The study group consisted of 37 patients with a history of at least two syncopal episodes in the past 6 months, in whom syncope was reproduced during TT. After positive baseline TT the patients were returned to supine position and were given intravenous propranolol. After 15 min supine rest the patients were tilted again using the same protocol as during the baseline test. Propranolol was considered effective when the result of the second (on drug) TT was negative or the time to syncope occurrence was longer than during baseline TT. During the whole procedure systolic BP (SBP), mean BP (MBP), diastolic BP (DBP) and HR were measured. These parameters were analysed in four different time-intervals: period I - between 13th and 15th minute of supine rest preceding the passive phase of TT, period II - between first and third minute of the passive TT, period III - following propranolol injection, between 13th and 15th minute of supine rest preceding second TT, and period IV - between first and third minute of second TT, either passive (if positive) or after NTG administration. Both, mean values and differences (Delta) in analysed parameters between various time-intervals (II-I, III-I, IV-II and IV-III) were taken into account. RESULTS: Intravenous propranolol occurred effective in preventing syncope during second TT in 29/37 (78%) patients. The DeltaSBP, DeltaMBP and DeltaDBP values calculated from periods III and IV were significantly different between patients with or without protective effects of propranolol. The cut-off values which were computed to obtain the highest value of total predictive accuracy (the highest value of the sum of sensitivity and specificity) were -5 mmHg for DeltaSBP, -4 mmHg for DeltaMBP and -2 mmHg for DeltaDBP. A stepwise logistic regression analysis revealed that DeltaSBP of -5 mmHg or less had the highest value in the prediction of a positive response to propranolol, reaching a sensitivity of 72%, specificity of 88%, positive predictive value of 95% and negative predictive value of 48%. CONCLUSIONS: Propranolol-induced changes in blood pressure values may predict the effectiveness of beta-blockade in preventing syncope during second TT performed after intravenous infusion of propranolol. A drug-induced reduction in systolic blood pressure of less than 5 mmHg may identify those who will benefit from beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed2003

The usefulness of tilt testing with an intravenous beta-blocker in assessing the efficacy of long-term therapy in patients with vasovagal syncope.

BACKGROUND: Although beta blockers are frequently used for the prevention of recurrences of vaso-vagal syncope, the prediction of the long-term efficacy of this treatment is difficult. AIM: To assess whether the result of tilt testing with an intravenous beta blocker can predict the long-term efficacy of beta blockade. METHODS: The study group consisted of 62 patients (29 females, mean age 32.8+/-12.3 years and 33 males, mean age 35.9+/-18.2 years) with at least two syncopal episodes during the six months preceding positive tilt testing. After baseline tilt test, propranolol in a dose of 0.1 mg/kg body weight was administered intravenously and the tilt test was repeated. Beta blockade was defined effective if the second tilt test was negative (complete efficacy) or the time to syncope during tilt testing was increased compared with the baseline tilting (partial efficacy). All patients received chronic propranolol treatment and were followed for one year or till the recurrence of syncope. RESULTS: Intravenous propranolol prevented (n=33) or delayed (n=18) syncope during tilt testing in 51 (82%) patients whereas it was ineffective in the remaining 11 (18%) patients. During 8.6+/-6.7 (range 1-14) months of follow-up, 20 (32%) patients had syncope recurrence; 13 (25%) from the group with effective intravenous propranolol versus 7 (64%) patients in whom intravenous propranolol did not prevent syncope during tilt testing (p<0.015). Analysis of survival without a recurrence of syncope revealed a significant relationship between the results of tilt testing with intravenous propranolol and the efficacy of long-term beta-blocker therapy (p<0.003). There were no significant differences between the predictive value of tilt testing with propranolol between patients with complete or partial propranolol efficacy (NS) whereas significant differences between each of these two groups and patients with ineffective intravenous propranolol were noted (p<0.04 and p<0.002, respectively). CONCLUSIONS: Propranolol administered intravenously prevents syncope during tilt testing in a significant proportion of patients. Both complete or partial efficacy of intravenous propranolol predict long-term efficacy of chronic beta blocker therapy in patients with vaso-vagal syncope.

Administration, Oral↗
PubMed2003

[Usefulness of the tilt test with nitroglycerine application in diagnosing of patients with unexplained syncope: new aspects of the well-known problem].

INTRODUCTION: The head-up tilt test (TT) performed after sublingual nitroglycerine application (NTG) is a tool that is commonly accepted and widely used in diagnosing patients with unexplained syncope. Although the results of conducted trials suggest advantages related to the protocol of TT with NTG, but data concerning the special diagnostic value of this protocol and the circumstances when it is superior to the passive TT, have not been established yet. The aim of the study was to analyse the problem whether there is, and if so, what circumstances it is related to, any special value of TT with NTG in diagnosing patients with vasovagal syncope. MATERIAL AND METHODS: 112 subjects were examined, 67 men and 45 women, at the mean age 34.4 +/- 19.1, and 42.6 +/- 17.4 years (p = 0.07), respectively, with at least two events of unexplained syncope. The control group consisted of 35 healthy volunteers matched for age and sex (18 men and 17 women), at the mean age 39.4 +/- 12.6 years (18-77 years) without syncope in anamnesis. All patients underwent a passive tilt test (Westminster protocol- 60 degrees/45 min) and in the case of lacking response to the passive test, the patients received 0.25 mg NTG and the test was continued over the next 20 minutes. The type of syncope reaction was determined based on the ACC classification (1996). If vasovagal syncope occurred, its type was defined according to the VASIS classification. RESULTS: The passive TT defined the reason of syncope in 31 patients (28% of all examined subjects), whereas TT with NTG increased this group by another 37 patients (33%), so that 68 patients (61%) were diagnosed using both protocols. The analysis of the study population that was sensitive to TT revealed that the group of patients who had vasovagal syncope during the test was greater than the group of patients who had other, i.e. non-vasovagal, type of reaction (48 vs 20, p = 0.002). There was a statistically significant relationship between the method of provocation and the type of reaction (chi 2 = 6.8, p = 0.009). The age difference between the groups of patients who developed vasovagal reaction during passive TT and patients who developed this type of reaction during TT with NTG (27.3 +/- 11.5 vs 39.9 +/- 20.3, p = 0.005) was also statistically significant. In the context of these results, concerning the mentioned groups of patients, the dichotomy division index of age was established: which was 30 and 50 years, respectively. A statistically significant relationship was found between the sex of the study population and the type of provocation (passive TT vs TT with NTG) resulting in syncope in sensitive patients (chi 2 = 2.84, p = 0.009). Fourteen (70%) women and only 23 (48%) men required NTG in order to establish the diagnosis, i.e. vasovagal background of syncope. CONCLUSIONS: 1. Vasovagal syncope seems to be a highly specific form of circulatory response to TT and requires application of NTG statistically more often than other types of neurocardiogenic reactions. 2. TT with NTG is especially justified in women and patients of either sex older than 50 years.

Adolescent↗