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Remigijus Zaliūnas

Publications and source records attributed to Remigijus Zaliūnas.

12 recordsLinked to original sources
PubMed2006

QT dispersion and heart rate variability in sudden death risk stratification in patients with ischemic heart disease.

The aim of the article is to review the literature data about the significance and problems of the QT dispersion and heart rate variability in sudden death risk stratification in patients with coronary heart disease. QT dispersion is defined as the difference between the longest and the shortest QT intervals as measured in the 12-lead electrocardiogram. A direct relationship between the prolongation of QT dispersion and myocardial ischemia has been reported by several authors. Our previous study showed that QT dispersion assessed immediately after bicycle exercise test was significantly higher in patients with coronary stenoses of > 50% as compared to the patients without coronary artery disease. Despite some controversial data, several studies showed that QT dispersion is a significant predictor of cardiovascular mortality. Heart rate variability representing a relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, is one of the most promising markers. The predictive value of heart rate variability is independent of other factors established for postinfarction risk stratification, such as depressed left ventricular ejection fraction, increased ventricular ectopic activity, and presence of late potentials. For prediction of all-cause mortality, the value of heart rate variability is similar to that of left ventricular ejection fraction, but heart rate variability is superior to left ventricular ejection fraction in predicting arrhythmic events (sudden cardiac death and ventricular tachycardia).

Cardiotonic Agents↗
PubMed2005

Effects of amlodipine and lacidipine on heart rate variability in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction.

OBJECTIVE: To estimate the influence of therapy with amlodipine (A) or lacidipine (L) on heart rate variability (HRV) time and frequency domain parameters in hypertensive patients with stable angina pectoris and isolated left ventricular diastolic dysfunction. METHODS: After a 1-week washout period, the patients were randomized to receive amlodipine 10 mg (30 patients) or lacidipine 6 mg (30 patients) once-daily for 4 weeks. HRV parameters were determined over a period of 24 h, echocardiography and exercise test were performed before and after treatment. RESULTS: All HRV time domain parameters after applying amlodipine did not change significantly. A reliable decrease only of the root mean square of differences between adjacent normal-to-normal intervals (RMSSD)-32.9 +/- 13 vs. 27.5 +/- 9-was noticed after treatment with lacidipine. In the lacidipine group, the change of RMSSD negatively correlated with the extent of ST segment depression during exercise testing (R = -0.43; P < 0.05). Both drugs reduced total power (A, 2234 +/- 1270 vs. 1813 +/- 889; L, 2205 +/- 1151 vs. 1825 +/- 896; P < 0.01), very low (A, 1451 +/- 733 vs. 1143 +/- 534; L, 1413 +/- 759 vs. 1213 +/- 616; P < 0.05), and low frequency power (A, 610 +/- 459 vs. 447 +/- 321; L, 569 +/- 323 vs. 442 +/- 241; P < 0.01). After amlodipine, high frequency power remained unchanged, whereas low-high frequency ratio decreased (4.54 +/- 1.72 vs. 3.77+/-1.73; P < 0.05). After lacidipine, high frequency power decreased (178.8 +/- 153.2 vs. 132.1 +/- 79.3; P < 0.05), whereas the ratio of low frequency to high frequency did not change. CONCLUSIONS: Amlodipine and lacidipine reduce the influence of humoral control and sympathetic autonomic nervous system activity. The autonomic balance becomes shifted toward the increased vagal activity only by amlodipine.

Adult↗
PubMed2005

[Cardiac events and 5-year survival after acute coronary syndromes].

OBJECTIVE: To evaluate the incidence of cardiac events and survival in patients with first acute coronary syndromes during 5-year period. METHODS AND RESULTS: Data on 732 patients admitted with first acute coronary syndrome were collected in a database. During hospitalization period 45.4% of the patients received reperfusion therapy. During follow-up period (4.49+/-2.1 years) 215 (29.4%) patients had cardiac events: 15.3%--myocardial revascularization, 8.1%--repeated myocardial infarction, 11.5%--cardiovascular deaths. The highest (5%) mortality rate was during first year, whereas during the following four years--1.5% annually. Kaplan-Meier analysis for survival free of cardiovascular death revealed that mortality rates were higher among patients who were > or =65 years old (long-rank test, p=0.02); had heart failure at admission (p=0.003), left ventricular ejection fraction <40% (p=0.04), significance diastolic dysfunction (p=0.035), III-IV degrees mitral regurgitation (p=0.00006); did not received reperfusion therapy (p=0.007). CONCLUSION: The analysis of this long-term follow-up data shows that the patients with acute coronary syndromes carry a high risk of death and need better treatment strategies to reduce risk.

Acute Disease↗
PubMed2005

[Relationship between the metabolic syndrome, endothelial function and intima-media thickness in asymptomatic middle-aged individuals].

OBJECTIVE: To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima-media thickness in asymptomatic middle-aged individuals. MATERIALS AND METHODS: A total of 180 subjects (86 men and 94 women, mean age 38.8+/-0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). RESULTS: The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima-media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (alpha=0.000, beta=0.01). Endothelial dysfunction and intima-media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood triglyceride and glucose levels. Intima-media thickness was greater in individuals with impaired endothelial function in all carotid segments tested. No relationship has been observed between total or low-density lipoprotein cholesterol concentrations and endothelial function, intima-media thickening or high sensitivity C-reactive protein levels. CONCLUSIONS: These observations suggest that the metabolic syndrome and/or its components may influence the different initial mechanisms of atherosclerosis--disorder of endothelial function and intima-media thickening. It is presumable that the lipid disorders as well as inflammation may play more significant role in the presence of impaired endothelial function.

Adult↗
PubMed2005

[The prevalence of metabolic syndrome in middle-aged in Kaunas population].

AIM: To assess the prevalence of the metabolic syndrome among middle-aged Kaunas population. MATERIAL AND METHODS: A total of 433 (192 males and 241 females, mean age 38.8+/-0.3 years) asymptomatic individuals have been investigated. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria - central obesity (the waist circumference > or =94 cm for men and > or =80 cm for women) plus any two of the following four factors: elevated triglycerides (Tg) (> or =1.7 mmol/L), low high-density lipoprotein cholesterol (HDL-C) levels (<1.0 mmol/L for men and <1.3 mmol/L for women), blood pressure (BP) of 130/85 or higher (systolic pressure >130 mmHg or a diastolic pressure >85 mmHg) or hyperglycemia (> or =5.6 mmol/L). RESULTS: The metabolic syndrome was present in 21.7% (28.1% among males and 16.6% among females) of individuals. Furthermore, 41.1% had an increased waist circumference, 56.4% had elevated BP (130/85 or higher), 31.2% had elevated plasma glucose concentration, 19.9% had low HDL-C cholesterol values and 14.1% had increased Tg values. Significantly higher concentration (1.16 mg/L, alpha<0,001, beta<0.001) of high-sensitivity C-reactive protein has been established in individuals with the metabolic syndrome. An increased concentration (>3 mg/L) of high-sensitivity C-reactive protein was more prevalent (17.3%) in the cohort with metabolic syndrome. Concentration of high-sensitivity C-reactive protein directly correlated with the waist and hips circumference, body mass index, concentration of Tg, glucose and BP. CONCLUSIONS: The prevalence of the metabolic syndrome among middle-aged Kaunas residents was 22%. Metabolic syndrome and central obesity correlated with elevated concentration of high-sensitivity C-reactive protein. Moderately (1-3 mg/L) and severely (>3 mg/L) elevated high-sensitivity C-reactive protein levels increase the chance of metabolic syndrome by 4.15 and 7.39 times, respectively (p=0,000). An innovative approach towards cardiovascular risk assessment integrating traditional cardiovascular risk factors, metabolic syndrome and high-sensitivity C-reactive protein values could improve the risk stratification in asymptomatic middle-aged population.

Adult↗
PubMed2004

[Ischemic heart disease in women: prognostic value of ventricular repolarization variables].

The aim of the study was to evaluate changes of ventricular repolarization variables during the exercise test in women with coronary heart disease, to determine variables, which can best predict significant coronary artery stenoses, and to improve noninvasive diagnostics of coronary heart disease. Ninety women with unstable angina pectoris undergone coronary artery angiography and exercise test on 4th-6th day of hospitalization at Kaunas University of Medicine Hospital. There was no difference in ventricular repolarization variables (JT interval, JT dispersion, JT and ST product) in women without coronary artery stenoses and those with one or two coronary artery stenoses. Sensitivity (87%), specificity (60%), positive predictive (43%), negative predictive (93%) and diagnostic value (67%) of stress test variable, which had no correlation with heart rate -ST and JT product- was greater comparing with ST depression greater than 0.1 mV (values respectively 61%, 49%, 29%, 79%, 52%). JT dispersion at the peak of exercise greater than 33 ms had the best diagnostic value (77%). The most accurate predictors of three-vessel disease are JT dispersion, ST and JT product at the peak of exercise and the fact of previous MI: JT dispersion at the peak of exercise more than 33 ms significantly increases three-vessel disease odds ratio 7.95 times. ST and JT product greater than 22,38 mV x ms significantly increases three-vessel disease odds ratio 13.9 times. The fact of previous MI significantly increases three-vessel disease odds ratio 6.85 times.

Aged↗
PubMed2004

Lethal outcomes in patients with symptomatic heart failure developed after Q-wave myocardial infarction.

The article analyses clinical characteristics and mortality of patients with symptomatic chronic heart failure following Q-wave myocardial infarction. During the study 224 patients (mean age 64.1+/-9.7) with symptomatic chronic heart failure and left ventricular ejection fraction <40% were followed-up for 1-5 years (on the average, 2.6+/-2.0 years). The majority of the studied patients had had anterior or anterior-lower Q-wave myocardial infarction (61.6% and 25.9%, respectively) and an identified Canadian function class II-IV angina pectoris (74.6%), and one-fifth of the patients (19.6%) had unstable angina pectoris. All patients were diagnosed with chronic heart failure New York Heart Association function class II-IV, the majority of patients had disturbances in cardiac rhythm and conduction, almost a half of them (46.0%) had left ventricular aneurysm, 92.8% of patients were diagnosed with marked changes in left ventricular geometry, 84.4% of patients had II-IV degrees mitral regurgitation, a half of the patients had significant left ventricular diastolic dysfunction, and 6.3% of patients had previously experienced thromboembolic complications. During the follow-up period 132 patients died. The comparison of the characteristics of patients who survived with those of patients who died showed that the deceased patients were statistically significantly older compared to survivors; in addition to that, marked stenoses of three coronary arteries, severe chronic heart failure, ejection fraction < or =20%, ventricular extrasystoles, and sinal tachycardia were more common in the former group, and patients who died less frequently were overweight and less frequently used beta adrenoblockers. The evaluation of Kaplan-Meier curves showed that total mortality resulting from the development of chronic heart failure symptoms and indications of chronic heart failure during the 1st year was 21.0%, during the 2nd year -40%, during the 3rd year -55.0%, during the 4th year -61.0%, and during the 5th year -65.0% the highest mortality was observed when left ventricular ejection fraction < or =20%, and age >75. The development of severe chronic heart failure resulted, on the average, after 1.5+/-1.1 years. It is obvious that symptomatic chronic heart failure caused by ischemic cardiomyopathy and marked left ventricular systolic dysfunction following Q-wave myocardial infarction is a rapidly progressing process conditioning high risk of lethal outcome within the period of several years.

Adult↗
PubMed2004

[Treatment of patients with ischemic heart disease and diabetes].

Around one third of patients with myocardial infarction are diabetic. More vigorous control of hyperglycemia, hyperlipidemia, and hypertension is likely to be of crucial importance for risk reduction. Although the effect of intensive glycemic control appears to be only minor in terms of prevention of cardiac events in diabetic patients, it has a major beneficial impact during acute myocardial infarction and after percutaneous transluminal coronary angioplasty. Lipid-lowering treatment is as effective in diabetic patients with coronary artery disease as in nondiabetic patients. In patients with coronary artery disease, there is strong evidence in favor of the use of b-blockers soon after myocardial infarction as well as in the long term. The metabolic treatment may also be considered as a rational approach for patients with stable angina. The long-term angiotensin converting enzyme inhibitor trials in patients with left ventricle dysfunction soon after myocardial infarction demonstrated a substantial benefit in the subgroup of diabetic patients. Current evidence leads us to recommend revascularization surgery as the first choice in diabetic patients. The management of risk factors should be more intensive in diabetic patients. In diabetic patients with coronary artery disease, most of the medical strategies are as effective as in nondiabetic patients.

Adrenergic beta-Antagonists↗
PubMed2003

[Ischemic heart disease mortality risk in patients with diabetes mellitus].

AIM: The significance of clinical characteristics during acute phase of coronary syndrome for hospital prognosis is well established. However their prognostic ability and impact on defining risk of lethal outcome during one-year period after acute coronary syndrome in pts with diabetes mellitus is not clarified. METHODS: In a prospective one-year study 699 pts with first acute coronary syndrome were studied: 61 with diabetes mellitus and 638 without diabetes mellitus. We have analyzed their demographic characteristics, risk factors of ischemic heart disease, clinical, echocardiographic, angiographic data. During one year follow up period there were 61 cases of cardiac death. RESULTS: Univariate analysis showed, that pts with diabetes mellitus vs pts without diabetes mellitus more often were female, aged >65 years, had arterial hypertension, obesity and sinusal tachycardia, severe acute left ventricular failure, three - vessel coronary disease, episodes of paroxysmal atrial flutter during acute phase of acute coronary syndrome (p<0.05). Multivariate logistic regression analysis showed that these variables remained independent predictors for lethal outcome and had OR from 1.6 to 9.5 in pts without diabetes mellitus. The presence of diabetes mellitus increased the value of OR of these variables 1.5-2.5 fold and this followed to the further stratification of pts. The value > and =14 of general risk score in multivariate model indicated the high risk for lethal outcome during one-year period. Almost half of pts (48.3%) with diabetes mellitus had the high risk, a 36.5 percent of them died during follow up. The sensitivity of risk score in predicting mortality was 37.3 percent in high risk group and 58.8 percent in low risk group, specificity--96.7 percent and 82.7 percent respectively. CONCLUSION: These results imply that the presence of diabetes mellitus in pts with acute coronary syndrome increases risk for lethal outcome two-fold during one-year period after acute coronary syndrome.

Age Factors↗
PubMed2003

[Low density lipoprotein apheresis].

Increased blood cholesterol concentration is one of the main factors in ischemic heart disease, development of which is determined by atherosclerotic changes in coronary vessels. Diet and treatment with 3-hydroxi-3-metilglutaril coenzyme A (HMG-CoA) reductase inhibitors helps to reduce low density lipoprotein cholesterol (LDL-Ch) blood concentration up to recommended level of 3.0 mmol/l in most patients but in some patients particularly with familial dyslipidemias cholesterol concentration remains increased even after treatment with maximal doses of lipid-regulating agents or their combinations. The most frequently used mechanical methods of cholesterol removal from blood include the procedures of extracorporeal apheresis. Low density lipoprotein (LDL) apheresis not only significantly reduces the blood concentrations of total cholesterol (TCh), and LDL-Ch, lipoprotein (a) (Lp(a) and fibrinogen but also stops the progression of atherosclerosis in coronary vessels.

Adult↗
PubMed2002

[Cocaine-induced myocardial infarction (clinical case report)].

Cocaine abuse has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. The first report of myocardial infarction temporally related to the recreational use of cocaine appeared in 1982. This article discusses the possible pathological mechanisms underlying the pathogenesis of myocardial ischemia and infarction secondary to cocaine abuse, and current ideas on the management of cocaine-induced myocardial infarction. We report a case of acute myocardial ischemia in a young healthy male patient and his 5-year follow-up.

Adult↗