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Z Gasior

Publications and source records attributed to Z Gasior.

At least 19 recordsLinked to original sources
PubMed2001

[Side effects during dobutamine stress echocardiography in patients with aortic stenosis].

The purpose of the study was to assess the safety of the dobutamine stress echocardiography (DASE) in patients with aortic stenosis (AS). 161 patients (mean age 59 +/- 13 years) with AS were prospectively studied with DASE. There were 58 female and 103 male. Dobutamine was given in stepwise increasing doses from 5 to 40 ug/kg/min. Mean maximal dose achieved was 31.4 ug/kg/min. The test was positive in 40 (24.8%) patients. Significant coronary artery disease was present in 60 (37.3%) patients. DASE resulted in significant increase in transvalvular mean gradient from 29.3 +/- 12.5 mmHg at rest to 46.3 +/- 19.3 mmHg at peak dose. There was no significant increase in valve area. There were no death, myocardial infarction or episodes of sustained ventricular tachycardia as a result of DASE. The test was terminated when following conditions were revealed: target heart rate (39.1%), left ventricular asynergy (25.5%), maximal established dose achieved (8.1%), side effects (27.3%). The most common side effects with the need of test cessation were arrhythmias (9.9%) and hypotension (9.9%). The most side effects were usually well tolerated without need of medical treatment. We conclude that DASE may be safely performed in patients with AS. Side effects are more common than in patients with coronary disease, but are usually well tolerated without need of medical treatment.

Adult↗
PubMed2001

[Is application of electrocardiographic exercise test always usefull in the diagnosis of coronary artery disease? Advantages and limitations of this method].

UNLABELLED: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. Clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery. RESULTS: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%. CONCLUSION: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

Adult↗
PubMed2000

[ECHO image quality of the left ventricle during dobutamine stress echocardiography].

This study aimed at assessing ECHO image quality of the left ventricle during dobutamine stress echocardiography (ED). The study involved 582 patients without previous myocardial infarction. Their age ranged from 27 to 74 years, mean age 52 +/- 9. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg per minute. Atropine was added in 253 (43%) cases. The wall motion asynergy was evaluated by left ventricular echo image divided into 16 segments. At least one segment has not been visualised in 5.5% of patients. At the peak dose of administrated dobutamine (> 20 mcg/kg per minute) it increased to 6.1%. Unvisualized segments did not impair the test and did not affect negative or non diagnostic results, as was verified statistically. Patients' age, body weight and BMI did not exert a significant effect on the quality of echo image. Segments 5 and 11 were seen constantly during the whole test. Segment 13 was poorly visualised during the tests. Only in 1.5% of patients peak dose of dobutamine deteriorated the image, especially in segments 1, 3, 6, and 12. During the dobutamine echocardiography test the quality of ECHO image of left ventricular wall was worsening only in a few patients. It was not considered the reason of test interruption and did not impared the results of ED.

Adult↗
PubMed2000

Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus cristalloid cardioplegia.

BACKGROUND: In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia. METHODS: To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively. RESULTS: The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb. CONCLUSIONS: The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.

Adult↗
PubMed1999

[The diagnostic value of resting electrocardiography in stable coronary artery disease].

The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.

Cardiac Catheterization↗
PubMed1999

[Side effects during dobutamine stress echocardiography: analysis of 582 studies].

The purpose of the study was to assess the safety, adverse effects and complications of the dobutamine stress echocardiography (ED). 582 patients without previous infarction were prospectively studied with ED. There were 196 female and 368 male, age varied from 27 to 74 years, mean 52. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg/min. Mean maximal dose achieved was 33 mcg/kg/min. Atropine was added in 253 (43%) cases. Significant coronary artery disease was present in 323 patients (53%). There were no death, no myocardial infarction or episodes of sustained ventricular tachycardia as a result of ED. The test was terminated when following conditions were revealed: target heart rate (28.9%), maximal established dose achieved (25.3%), left ventricular asynergy (19.6%), angina pectoris (10.8%), increase of systolic blood pressure above 220 mm Hg (2.6%), hypotension (7.6%), nonsustained ventricular tachycardia (1.7%). The most common non-cardiac side effects were skin tingling (19.8%), atypical chest pain(16.3%), palpitations (13.9%) and headache (7.9%). The most side effects were usually well tolerated, without the need for test cessation. The ED was terminated only in 4 (0.6%) patients because of non-cardiac side effects including nausea (0.3%) and headache (0.3%). We conclude that ED may be safely performed in routine clinical practice. Side effects were rare and usually minor. Most severe ischemic pain was relieved by test interruption and sublingual nitro-glycerine or short acting beta-blocker administration.

Adult↗
PubMed1998

[Surgical revascularization of the myocardium in patients with chronic coronary disease and depressed left ventricular function: 1-year observation].

Many reports confirm the importance and benefit of the surgical revascularization (CABG) in patients with ischemic heart disease and severely depressed left ventricular (LV) systolic function. This mode of treatment is better than medical therapy in patients with very low LV ejection fraction (LVEF) and can prolong the life. However, the effect of CABG on LV hemodynamics is still unclear. The aim of the study was: 1) to assess the effect of CABG on LV hemodynamics in patients with low LVEF and 2) to examine the influence of two types of cardioplegia-crystalloid (CC) and blood (BC) cardioplegia--on LV function during 1 year follow-up. 122 patients with stable angina pectoris qualified for CABG were included in the study. Patients were divided into two groups: group I-47 pts with LVEF < or = 40% and group II--75 pts with LVEF > 40% and then patients were randomized for two types of antegrade-retrograde cardioplegia (CC--subgroups Ia, IIa and BC--subgroups Ib, IIb). Before operation and 4 times after CABG (after 2-6 weeks, 3 months, 6 months and 1 year) echocardiographic examination was performed. Diameters of left atrium and ventricle, LVEF and wall motion score index (WMSI) were calculated. During 1 year 8 patients died (5 of them during perioperative period and 3 patients during follow-up). Patients in group I before operation were in higher NYHA and CCS class and had more often myocardial infarction. During each of the five echocardiographic examination the values of LVEF and WMSI did not differ between subgroups Ia vs Ib and IIa vs IIb. In group I, especially in patients with very low LVEF < or = 30%, the values of LVEF and WMSI improved significantly (p < 0.001) during 1 year of follow-up. But in group II a transient deterioration of LVEF (p < 0.05) 2-6 weeks after CABG was noted. We conclude that surgical revascularization in patients with severe depressed hemodynamics improves LV systolic function during 1 year follow-up. The use of CC or BC did not seem to make any difference to the early and long-term hemodynamic effect of the revascularization.

Coronary Artery Bypass↗
PubMed1997

[Evaluation of antiarrhythmic efficacy of sotalol in various doses in patients with ventricular tachyarrhythmias].

UNLABELLED: Antiarrhythmic efficacy of sotalol--noncardioselective beta-adrenergic blocking agent with class III antiarrhythmic action was evaluated in 34 patients [pts] (mean age 55 +/- 11) with chronic ventricular arrhythmias and coronary artery disease, 38% with previous myocardial infarction. Two schedules of dosing were tested: 3 x 80 mg and 2 x 160 mg during 28 days of therapy. Pts with Lown class II and IV arrhythmia derived from 24-hours Holter recording were assigned. Ventricular premature complexes [VPCs] and couplets reduction by 80% and total elimination of runs defined antiarrhythmic efficacy. Proarrhythmia was defined by four times increase in VPCs, ten times increase in couplets and runs or sustained VT episodes. RESULTS: Antiarrhythmic efficacy of two doses of sotalol according to study criterion was: 31% for lower dose (3 x 80 mg) and 24% for higher dose (2 x 160 mg). Overall efficacy for both doses was 55%. According to Morganroth criterion, lower dose was effective in 29% pts and both doses, lower and higher, in 41% pts. According to other commonly used criterion: 70% VPCs reduction, 90% couplets reduction and total elimination of runs, lower dose of sotalol was effective in 32% pts and both doses in 47% pts. Significant reduction of heart rate and prolongation of QT and QTc were observed. In 3 pts QT was prolonged over 500 ms. Proarrhythmia according to Velebit criterion was suspected in one patient after one week of 3 x 80 mg teratment which caused premature cessation of therapy. No significant abnormalities in laboratory values were observed. CONCLUSIONS: Antiarrhythmic efficacy of sotalol was comparable to other studies. Its value in pts with malignant ventricular tachyarrhythmias: sustained ventricular tachycardia and ventricular fibrillation requires further studies with higher number of patients.

Adult↗
PubMed1996

[Echocardiography examinations in children suffering from cutaneous forms of scleroderma].

In 34 children suffering from so called cutaneous forms of scleroderma and in 30 healthy subjects echocardiographic cardiac assessment as well as doppler analysis of mitral valve function was performed. It was found that sclerodermic children suffered more frequently from cardiac valves regurgitation (especially insufficiency of mitral valve). However, these insufficiencies were usually negligible or corresponding to Io. Other changes detected in these children were as follows: significantly higher values of left ventricle shortening fraction, increased left ventricle mass index, and changes of mitral flow which may reflect impaired diasystolic function of left ventricle and, perhaps, impaired left atrium contraction. It is suggested that such changes could be corresponding to the beginning of cardiomyopathy.

Adolescent↗
PubMed1995

[The circulatory system in children with cutaneous forms of scleroderma. The results of routine as well as 24-hour ECG and physical performance test].

Thirty-four children suffering from so-called cutaneous forms of scleroderma were studied (physical examination, routine and 24-hour ECG, and physical performance test). Physical development was significantly impaired in 5 cases. Congenital heart malformations with left-to-right shunt were detected in 3 children. These children underwent surgery with good results. Heart murmur was found during physical examination in 14 cases. In 30 subjects routine ECG was described as abnormal or doubtful. Abnormal Holter monitoring results were found in 13 children. The authors were not able to detect inferior physical performance test results in the studied children as compared to the control group (when the children suffering from congenital heart malformations and resting tachycardia were excluded from the study). It is suggested that children suffering from so-called cutaneous forms of scleroderma should remain under constant cardiological care.

Adolescent↗
PubMed1994

[Left ventricular systolic function after PTCA--recent and late assessment by exercise echocardiography].

The purpose of this study was to determine whether global and segmental left ventricle (LV) systolic function, assessed by exercise echocardiography (EE), improves after PTCA in patients without previous myocardial infarction (MI) and after infarction and angioplasty of infarct related coronary artery. 32 patients without MI and 35 patients with previous (4 +/- 3 months) MI were examined before PTCA (percutaneous transluminal coronary angioplasty), 3-5 days after successful elective PTCA and 6 months later with EE (modified Bruce protocol). LV ejection fraction (EF) and wall motion score index (WMSI) at the baseline and immediately after exercise were assessed. Following angioplasty (after 3-5 days and 6 months later), exercise duration was significantly (p < 0.001) increased in both groups of patients. Resting EF and WMSI did not change after angioplasty of infarct-related artery, but in patients without prior MI resting EF increased (p < 0.001) after PTCA in comparison with pre-PTCA values. Significant improvement of exercise EF and WMSI were observed in both groups of patients. In 25 of 35 patients with old MI wall motion improvement in the infarcted region after PTCA was observed. Twenty of these 25 patients developed exercise-induced akinesia in this area during pre-PTCA EE. Among 10 patients without improvement of the regional contractility were 9 after type Q-wave infarction and only 2 developed angina during EE. These data demonstrate improvement in global and regional systolic LV function and better exercise tolerance following successful PTCA both in patients without prior MI and with old MI after angioplasty of a stenosis in an infarct-related coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Effect of ventricular and sequential stimulation on the left- ventricular systolic function].

Left ventricular systolic function at rest was determined by echocardiography and Doppler in 20 patients after dual chamber pacemaker implantation due to second and third degree A-V block. Measurements were performed in each patient during VVI and DDD mode pacing at three different atrio-ventricular (A-V) intervals: 100, 150 and 200 ms. The essential hemodynamic superiority of DDD stimulation over VVI mode in the form of significant increase of forward stroke volume index (SVI) and cardiac index (CI) during dual chamber stimulation at identical rate stimulation was observed. Closer individual analysis of the values of CI during DDD stimulation at three different A-V intervals (100, 150 and 200 ms) gave the possibility of programming optimal A-V intervals (the highest value of CI) for each patient. The sequential atrio-ventricular stimulation as compared to right ventricular stimulation essentially improves the left ventricular systolic function at rest in patients without symptoms of heart failure. Maximum hemodynamic advantage during DDD stimulation depends on individual selection of A-V delay in each patient.

Adult↗
PubMed1992

[Effect of physical exercise on the function of prosthetic heart valves--evaluation by doppler echocardiography].

Although considerable data exist regarding the function of prosthetic heart valves (PHV) at rest, few data exist regarding the response to exercise. Thus, we studied by Doppler echocardiography 81 asymptomatic patients with PHV (46 mitral, 45 aortic) of varying type and 20 normal persons before and after symptom limited upright bicycle exercise. Rest and exercise hemodynamics (blood velocity, gradients, heart rate, stroke volume and cardiac output) was examined. In patients with mitral PHV maximal (Gmax) and mean (Gmean) gradients increased from 9.9 to 17.8 mmHg and from 4.4 to 7.8 mmHg (both p < 0.001), respectively. In patients with aortic PHV Gmax and Gmean increased from 27 to 42 mmHg and from 16 to 24 mmHg (both p < 0.001), respectively. Linear regression analysis demonstrated a relationship between the % change in gradient with exercise nd % change in stroke volume and cardiac output. Importantly, the largest gradient produced by exercise is related and predicted by the rest gradient. In comparison with normal valves, maximal and mean blood velocity were significantly (p < 0.001) greater across PHV, but % change in velocity with exercise did no differ significantly between prosthetic and normal valves. In conclusion, exercise Doppler echocardiography provides a good method to assess PHV function.

Adult↗
PubMed1992

[PTCA and left ventricular systolic function (evaluation by exercise two-dimensional echocardiography)].

Successful transluminal coronary angioplasty (PTCA) should improve left ventricular systolic function. To assess the effect of this procedure 25 patients with coronary heart disease were examined before and 3-to 5 days after successful PTCA with electrocardiographic treadmill exercise test, and exercise two-dimensional echocardiography (modified Bruce protocol). Echocardiographic examination was obtained prior to and immediately following exercise. Left ventricular ejection fraction and segmental wall motion at the baseline and immediately after exercise were assessed. Electrocardiographic evidence of ischemia was found in 16 of 25 patients prior to PTCA and in 9 patients after PTCA. Following angioplasty, exercise duration was increased and the exercise-induced angina rate was significantly decreased. Ejection fraction did not change significantly in patients prior and after PTCA (52 +/- 10% versus 55 +/- 16%, p = NS). Following angioplasty, ejection fraction increased from 55 +/- 10% (rest) to 64 +/- 11% (exercise) (p less than 0.001). New exercise-induced echocardiographic segmental wall motion abnormalities were found in 16 of 25 patients prior to PTCA and in only one patient following PTCA. Significant improvement of ejection fraction and segmental wall motion were also observed in 11 patients with old myocardial infarction subjected to successful angioplasty of infarct-related coronary artery. Opposite to post-exercise results, the resting mean values of these echocardiographic parameters did not differ significantly between pre and post-PTCA examinations. These data demonstrate an improvement in systolic left ventricular function and better exercise tolerance following successful PTCA. This occurs also in patients with old myocardial infarction after angioplasty of infarct-related coronary artery. Two-dimensional exercise echocardiography may be helpful in assessing the early results of successful angioplasty.

Adult↗
PubMed1990

[Programmed electrical stimulation of the heart in relation to left ventricular contractility in ischemic heart disease].

To determine the relation between left ventricular contractility disorders and the inducibility of serious ventricular arrhythmias, 83 patients (pts) with ischaemic heart disease and ventricular tachycardia (VT) or fibrillation (VF) in history and/or Lown's class IVb arrhythmia in 24-hour Holter ECG monitoring were evaluated by means of echocardiography and programmed electrical stimulation (PES) of the heart. Inducible VT or VF were observed in 66% of pts: sustained monomorphic VT (SMVT) in 33%, nonsustained VT (NSVT) in 28% and VF in 6%. VT or VF were significantly more frequent in patients with VT/VF in history (91% vs 42%, p less than 0.001), SMVT (48% vs 17%, p less than 0.01) as well as NSVT (38% vs 17%, p less than 0.01). Low ejection fraction (EF less than 40%) was observed in 18 pts (22%), VT/VF was inducible in 94% of them, while only in 57% with EF greater than or equal to 40%, p less than 0.01, SMVT in 39% vs 30%, NSVT in 33% vs 25%. Among 21 pts (21%) with left ventricular (LV) dyskinesis in 91% of pts while only in 55% without it, p less than 0.01, SMVT in 53% vs 26%, p less than 0.05. We concluded that in patients with previous myocardial infarction, VT/VF in history and abnormal LV contractility full haemodynamic, angiographic and electrophysiologic examination should be performed to determine their risk of sudden death due to serious ventricular arrhythmia before final decision about the mode of treatment.

Adult↗
PubMed1990

[Effects of antiarrhythmic drugs on some echocardiographic parameters of left ventricular function in patients with ischemic heart disease].

This study was performed to evaluate the effects of antiarrhythmic drugs on left ventricular function in 843 patients with ischaemic heart disease and ventricular arrhythmias (Lown classes 2-5). Rhythm abnormalities were observed by ambulatory electrocardiographic monitoring before and after 2-weeks of antiarrhythmic therapy. Haemodynamic variables such as cardiac output (CO), ejection fraction (EF), stroke volume (SV), and ratio of myocardial contractility (RMC) were derived from the cross sectional echocardiography. Efficacy of the applied drugs was 42-71%. Of these antiarrhythmic agents only propranolol caused the deterioration of left ventricular performance, measured by CO; in mono-therapy propranolol produced significant changes (p less than 0.05), in combination with amiodarone--at point of significance. Mexiletine produced significant improvement in EF and SV (p less than 0.05). There were no significant changes in haemodynamic parameters after treatment with the other drugs.

Adult↗