O fenômeno do precondicionamento isquêmico é definido como o aumento da tolerância à isquemia e à lesão de reperfusão, induzida por curtos e sucessivos episódios de isquemia prévios a período de isquemia prolongada. A angina do aquecimento e a de pré-infarto são duas condições clínicas relacionadas ao precondicionamento. Este fenômeno apresenta duas fases distintas, clássica ou precoce e tardia. A atenuação do infradesnível do segmento ST provocada pelo precondicionamento precoce está bem documentada, porém sua expressão cintilográfica permanece controversa. O objetivo desta pesquisa foi avaliar se as atenuações eletrocardiográficas do precondicionamento durante testes sequenciais estão associadas a modificações simultâneas das imagens de cintilografia de perfusão miocárdica em indivíduos com doença coronariana. Vinte e três pacientes foram selecionados entre março de 2009 e julho de 2011. A média de idade foi 64,5 anos (dp=7,0), 19 (82,6%) do sexo masculino e todos tinham lesão coronária em pelo menos um vaso superior a 60%. A medicação antiisquêmica foi suspensa por três a cinco dias. Os pacientes foram submetidos a três testes ergométricos a partir do exame de seleção, sendo dois deles sequenciais e o terceiro realizado após sete dias. A injeção do radiofármaco sestamibi-Tc-99m no teste de precondicionamento e contraprova foi administrado no tempo de aparecimento do infradesnível de ST de -2,0 mm na derivação MC5 e/ou dor precordial anotados no teste inicial ou de seleção. A imagem cintilográfica foi adquirida entre 60 a 90 minutos após o esforço. Os resultados do segundo teste (precondicionamento) mostraram aumento significativo do tempo para o aparecimento da depressão do segmento ST de 1,0 mm (338±130) e 2,0 mm (431±126), em relação ao teste inicial (245±96; 366±103) p<0,001. A diferença na redução do valor máximo de infradesnível de ST entre os três testes foi significativa (3,8±0,8; 2,3±0,6; 3,1±1,0) p<0,001. Houve redução significativa nos escores de perfusão de estresse (p=0,045) entre o primeiro e o segundo testes, bem como para o escore da diferença entre o estresse e repouso (p= 0,03), sem diferença na extensão da área de isquemia entre as três etapas detectadas pela cintilografia (p=0,691). Em conclusão, houve redução significativa das alterações eletrocardiográficas induzidas pelo precondicionamento isquêmico precoce em maior proporção do que as observadas nas respectivas imagens de cintilografia de perfusão miocárdica; não se observou associação entre a redução da depressão do ST e a redução do escore de perfusão na fase de precondicionamento, nem correlação entre a magnitude do infradesnível máximo de ST e a redução do escore de perfusão (r=0,07 e p=0,75). / The phenomenon of ischemic preconditioning is defined as the increase of tolerance to ischemia and injury of reperfusion induced by short and consecutive episodes of isquemia prior to prolonged arterial occlusion. Warm-up and pre-infarction angina are two clinical conditions regarding this phenomenon. The ischemic preconditioning has two distinct windows designed as classical and late. The improvement of ST depression induced by classical preconditioning is well documented, however its scintigraphy expression is still controversial. The aim of this research was to assess whether the reduction of ST depression induced by preconditioning during these sequencial exercise testing are associated to simultaneous alterations of the scintigraphy images of myocardial perfusion in individuals with coronary artery disease. From March 2009 to July 2011, 23 patients were selected, mean age 64,5 (sd=7,0), 19(82,6%) male. All patients had coronary artery stenosis at least 60% in one vessel. The anti ischemic therapy was discontinued for three days. Patients underwent three exercises testing after screening process; two of these tests were in a sequence and the other one performed after seven days. Tc-99m-sestamibi radiotracer injection was applied in the preconditioning test as well as for the third test at the time of development of ST depression 2,0 mm in the CM5 lead and/or chest pain estabilished in the screening process or first test. The scintigraphy image was obtained from 60 to 90 minutes after exertion. The results of the preconditioning test showed a significant increase of time for manifestation of the ST depression 1,0 mm (338±130) and 2,0 mm (431±126) regarding the first test (245±96; 366±103), p<0,001. There was a significant difference in the decrease of maximum value of ST depression among the three tests (3,8±0,8; 2,3±0,6; 3,1±1,0), p<0,001. A significant reduction in stress perfusion score (p=0,045) occurred between the first and second test as well as for the difference score between stress and rest (p=0,03). However, there was not a significant difference in the total defect size among the three stages detected by myocardial scintigraphy (p=0,691). In conclusion, there was a significant decrease of electrocardiographic alterations resulting from early preconditioning in greater proportion than the observed in scintigraphy images. It was not observed an association between the decrease of ST depression with the stress perfusion score during the preconditioning period nor the correlation between the magnitude of the maximum value of ST depression and the decrease of perfusion score (r=0,07 and p=0,75).

INTRODUÇÃO: A terapia de ressincronização cardíaca (TRC) é procedimento já incorporado às diretrizes do tratamento da insuficiência cardíaca crônica grave. Os efeitos sobre a repolarização ventricular são controversos e seu comportamento ainda precisa ser melhor definido por meios não invasivos. OBJETIVO: Analisar o comportamento da repolarização ventricular, através do mapeamento eletrocardiográfico de superfície (MES), em pacientes sob TRC. MÉTODOS: Foram estudados 52 pacientes sob TRC com indicação classe I das Diretrizes Brasileiras de Dispositivos Cardíacos Eletrônicos Implantáveis-2007, com idade média 58,8±12,3 anos, 31 homens, FEVE:27,5±9,2 e QRS:181,5±24,2ms. Foram excluídos os que não eram classe I e também os que usavam amiodarona, portadores de fibrilação atrial, marcapasso ou CDI prévios. O MES de 87 derivações (59 no tórax anterior e 28 no dorso) foi realizado em ritmo sinusal (BASAL) e sob efeito do ressincronizador (BIV) Através de medidas semiautomáticas foram obtidos o intervalo QT, QTc médio e a dispersão de QT (DQT) global das 87 derivações, nos dois modos de estimulação, em cada paciente. As mesmas medidas foram realizadas e comparadas nas três regiões discriminadas pelo MES (VD, Septo e VE). Caracterizamos assim, o comportamento global e regional do QT e sua dispersão na TRC. Utilizamos os testes t Student pareado e ANOVA para comparações múltiplas. Nível de significância de p< 0,05. RESULTADOS: O comportamento global do QTmédio foi sensivelmente menor em BIV que no BASAL (424,4±38,7 x 455,8±46,5ms; p<0,001), assim como o QTc médio (460,7±42,3 x 483,8±41,4ms; p<0,05) e a DQT (61,2±26,2 x 74,9±28,7ms; p<0,05). O QTmédio foi semelhante nas 3 regiões nos modos BASAL e BIV (p=ns), porém o QTc médio nas regiõess VD e VE mostrou-se significantemente menor no modo BASAL. Sob BIV, essa diferença foi notavelmente menor na região do VD. A DQT, em região do VE, por sua vez, foi significantemente menor em relação ao Septo, nos dois modos (BASAL: 40,5±23,1 x 55,7±28,7ms, p<0,01 e BIV: 30,6±20,4 x 47,1±20,2ms, p<0,001). A variação de efeito (D%) da TRC determinou redução do QTmédio nas 3 regiões (VD: p=0,0014; Septo: p=0,0001 e VE: p=0,0018), enquanto a DQT reduziu-se em VD: p=0,04 e VE: p=0,023. Em região septal, a redução da DQT não atingiu significância, embora tenha mostrado a mesma tendência de resposta. CONCLUSÃO: O Mapeamento Eletrocardiográfico de Superfície detectou redução global e regional dos valores da repolarização ventricular, através da análise do QTm, QTcm e DQT, por efeito da terapia de ressincronização cardíaca em pacientes com insuficiência cardíaca grave e BRE / BACKGROUND: Cardiac resynchronization therapy (CRT) is an already established procedure, which became part of the guidelines for severe chronic heart failure treatment. Its effects upon the ventricular repolarization are controversial, therefore CRT response still remains to be better defined by noninvasive methods. OBJECTIVE: The aim of this study was to analyze the ventricular repolarization response by body surface potential mapping (BSPM) in patients undergoing CRT. METHODS: Fifty-two patients undergoing CRT, mean age 58.8±12.3 years, 31 male, LVEF 27.5±9.2 and QRS duration 181.5±14.2ms, with indication class I of the 2007Guidelines for Implantable Electronic Cardiac Devices of the Brazilian Society of Cardiology, were studied. Those who were not in class I and/or in use of amiodarone, with atrial fibrillation, or with previous pacemaker or ICD, were excluded. Eighty-seven-lead BSPM examination (59 leads on the anterior chest and 28 on the back) was performed in sinus rhythm (BASELINE), and in biventricular pacing (BIV) with the resynchronization device on. Global values of QT and mean QTc intervals, and QT dispersion (DQT) were semiautomatically measured in all patients in the two pacing modes. Same measurements were made and compared in the three regions (RV, Septum and LV) discriminated by BSPM maps. Thus we characterized the global and regional QT response and its dispersion under CRT. t-Student paired test and ANOVA were used for multiple comparisons. Significance level: p<.05. RESULTS: The global mean QT response was considerably smaller in BIV pacing than in BASELINE (424.4±38.7 x 455.8±46.5ms; p<.001), and so were the mean QTc (460.7±42.3 x 483.8±41.4ms; p<.05) and DQT (61.2±26.2 x 74.9±28.7ms; p<.05). Mean QT was similar across the three regions in both pacing modes (p=ns); however, mean QTc in RV and LV regions was found to be significantly smaller in BASELINE. In BIV pacing such difference was considerably smaller in the RV region. On the other hand, DQT value in the LV region was significantly smaller compared to the Septum region in both modes (BASELINE 40.5±23.1 x 55.7±28.7ms. p<.01; and BIV 30.6±20.4 x 47.1±20.2ms. p<.001). Variation of CRT effect (D%) determined reduction of mean QT in the three regions, RV (p=.0014); Septum (p=.0001); and LV (p=.0018), while DQT was reduced in RV (p=.04) and LV (p=.023) regions. DQT reduction in the septal region was not significant, although it showed the same trend of response. CONCLUSION: body surface potential mapping detected reduction of global and regional ventricular repolarization values by analyzing QTm, QTcm and DQT variables under the effect of cardiac resynchronization therapy, in patients with severe heart failure and LBBB

O sistema Holter é considerado padrão ouro para detecção de arritmias cardíacas, possibilitando o seu diagnóstico e sua relação com os sintomas do paciente. As novas gerações de marcapassos (MP) detectam e registram eletrogramas intracavitários e poderiam dispensar o Holter no seguimento dos pacientes. Os diferentes MP dispõem de algoritmos de detecção de arritmias ventriculares (AV) que variam de acordo com o modelo e sua correlação diagnóstica com Holter foi pouco estudada. O objetivo desse estudo foi avaliar 1. a correlação entre o monitor de eventos dos MP e do Holter na detecção de AV e 2. a concordância das AV detectadas nos dois sistemas. Foram estudados129 pacientes portadores de MP com função de detecção de arritmias, com idade média de 68,6+19.1 anos (entre 19 e 94), 54,8% do sexo feminino. Os pacientes foram submetidos à monitorização com Holter por 72 horas. Assim que o sistema foi ligado, os contadores de eventos dos marcapassos foram reiniciados e os relógios sincronizados, para que ambos os sistemas detectassem os eventos simultaneamente. Os MP foram programados para detecção de eventos com o menor valor de frequência ventricular (FV) e o menor número de batimentos sequenciais (BT) possíveis. Depois de 72 horas, os sistemas Holter foram retirados e os registros analisados, assim como os registros simultâneos dos gravadores dos MP. Foram qualificados como eventos arrítmicos no Holter e MP, respectivamente: EV isoladas e \"PVC\"; extra-sístoles em pares e \"couplets\"; TVNS (> 3BT) e \"triplets\"(3BT), \"runs\"(3 a 8 ou > 8 BT) e \"HVR\" (3 ou 4 BT). As correlações de Spearman foram utilizadas para avaliar se o marcapasso acompanha a detecção dos parâmetros do Holter. Os coeficientes de correlação intraclasse e os respectivos intervalos com 95% de confiança, calculados para avaliar a concordâncias entre os parâmetros equivalentes do marcapasso e do Holter. Foram calculados os coeficientes Kappa para avaliar a concordância na detecção de > 10 \"PVC\"/h com > 10 EV/h. Resultados: Os monitores dos marcapassos subestimaram o Holter. Os registros de \"PVC\", \"triplet\" e \"HVR\" por TVNS apresentaram correlações positivas em relação aos parâmetros do Holter, sendo a mais alta aquela entre \"PVC\" e EV (r=0,501). Porém, a concordância entre os tipos de arritmias detectadas foi baixa (CCI < 0,5), exceção feita à concordância de \"triplet\" com TVNS de três batimentos (CCI=0.984). A concordância na detecção de mais de 10 PVC/h e mais de 10 EV/h foi moderada (kappa= 0,483), embora para os MP da Medtronic, o coeficiente de concordância foi alto (kappa=0.877). Para os MP com algoritmo de detecção de sequências de três batimentos com FV menor que 140bpm ( < 140/3), a correlação entre HVR e TVNS foi expressiva (r = 1), sendo a concordância entre esses parâmetros também bastante alta (CCI = 0,800). Conclusões: A correlação e a concordância na detecção de AV registradas nos MP e no Holter foram inconsistentes. Padronização dos algoritmos de detecção de AV, semelhantes os do sistema Holter, é necessária para que os pacientes portadores de dispositivos implantáveis possam se beneficiar dessa função para seguimento clínico e estratificação de risco / The Holter monitoring is considered the gold standard method for detection of cardiac arrhythmias, enabling its diagnosis and its correlation with the patient\'s symptoms. New generations of artificial pacemakers can detect and record intracavitary electrograms and, theoretically, could discard the Holter during the follow-up of the patients. Pacemakers have different ventricular arrhythmias (VA) detection algorithms, varying according to the model. Their diagnosis capacity comparing to Holter monitoring has been poorly studied. The aim of this study was to evaluate 1. the correlation between the event monitor of the pacemaker and the Holter in VA detection and 2. the agreement between the VA detected in both systems. We studied 129 patients with implanted pacemakers, which had arrhythmia detection function, mean age of 68.6 + 19.1 years (19 to 94), 54.8% female. The patients underwent Holter monitoring for 72 hours. Once the system was connected, event counters of pacemakers were reset and the clocks synchronized, so that both systems could detect the arrhythmic events simultaneously. The pacemakers were programmed to detect events with the lowest ventricular rate and lowest number of sequential beats allowed for each model. After 72 hours, Holter systems were removed and the records analyzed, as well as the simultaneous records of the pacemakers. Were considered as arrhythmic events: PVC isolated (in the pacemaker described as \"PVC\"); premature beats in pairs (pacemaker described as \"couplets\"); NSVT (pacemaker described as \"triplets\"- 3beats, \"runs\"- 4 to 8 or > 8 beats and \"HVR\"- 3 to 4 beats). Spearman rank correlations were used to assess whether the pacemaker and Holter identified the same parameters. The intraclass correlation coefficients and the respective intervals with 95% confidence were calculated to evaluate the concordance between the equivalent parameters of the pacemaker and Holter. Kappa coefficients were calculated to assess the agreement in the detection of > 10 PVC/h by the pacemakers and by the Holter. Results: The pacemakers underestimated the arrhythmias detection of Holter. Records of \"PVC\", \"triplet\" and \"HVR\" by NSVT showed positive correlations with the Holter parameters, and the highest one was among \"PVC\" and EV (r = 0.501). The agreement between the types of arrhythmias detected was quite low (CCI < 0.5), except for \"triplet\" detected by pacemakers and three beats NSVT by Holter (ICC = 0.984). The correlation detection for more than 10 PVC /h was moderate (kappa = 0.483), except for Medtronic pacemakers (kappa=0.877). When the pacemaker was programmed to detect sequences of three beats with heart rate lower than 140bpm ( < 140/3), the correlation between HVR and NSVT was perfect (r = 1) and the agreement between these parameters was also quite high (ICC = 0.800). Conclusions: The correlation and agreement between pacemakers and Holter monitoring in the detection of VA were not consistent. A standardization of the pacemakers\' detection algorithms is necessary before using this function for clinical follow-up and risk stratification of the patients

A hipertrofia ventricular esquerda (HVE) é importante fator de risco cardiovascular. O objetivo deste estudo retrospectivo foi verificar a associação de critérios eletrocardiográficos de HVE com as características anatômicas e histológicas do coração, em 51 pacientes submetidos à necropsia. Procedeu-se à medição do diâmetro transverso dos cardiomiócitos e da porcentagem de fibrose do ventrículo esquerdo e direito. Entre os pacientes que apresentavam HVE anatômica, o critério de Romhilt foi positivo em 92,3%, sendo superior aos demais critérios avaliados, com especificidade de 89,5% e sensibilidade de 68,8%, Foi o único que se associou a características anatômicas e histológicas do coração / The left ventricular hypertrophy (LVH) is an important cardiovascular risk factor. The purpose of the present retrospective paper is to examine the association of LVH electrocardiographic criteria with both anatomical and histological characteristics of the heart on 51 patients submitted to the necropsy. The study carried out the measurement of the transverse diameter of cardiomyocytes, as well as the percentage of fibrosis at both left and right ventriculi. Among those patients who presented anatomic LVH, the Romhilt criterium resulted positive in 92.3% of the cases, thus surpassing the other criteria evaluated, with specificity and sensibility up to 89.5% and 68.8% respectively. This was the only criterium associated to both anatomic and histological characteristics of the heart

A doença de Chagas é uma doença crônica causada pela infecção pelo protozoário Trypanosoma cruzi (T.cruzi). A sua principal consequência clínica é o desenvolvimento da cardiomiopatia chagásica crônica (CCC), que acomete 30% dos pacientes. Não foi determinado um indicador de evolução para a CCC ou permanência na forma indeterminada assintomática da doença de Chagas. Diversos trabalhos têm mostrado alterações no perfil de expressão gênica e proteômica ocorridas na fase aguda e crônica da doença de Chagas experimental e humana. Tais alterações advêm da regulação estabelecida em diversos estágios da expressão gênica e podem ser fatores relevantes no prognóstico da doença. Neste contexto, os microRNAs (miRs), podem exercer uma importante função reguladora. Sua ação se dá pela associação a um RNA mensageiro (RNAm) alvo, inibindo sua tradução ou degradando este transcrito. Assim, a hipótese deste trabalho é a de que a infecção aguda por T. cruzi modula a expressão de miRs no miocárdio de camundongos. Foi avaliado por qRT-PCR o perfil de expressão de miRs 15, 30 e 45 dias após a infecção. O perfil de expressão de miRs resultante foi suficiente para segregar os grupos de acordo com o tempo da infecção. O número de miRs diferencialmente expressos aumentou com a progressão da infecção. Além disso, seis miRs tiveram sua expressão correlacionada à piora na parasitemia e intervalo QTc dos animais: miR-142-3p miR-142-5p, miR-145, miR-146b, miR-149 e miR-21. Análises de correlação realizadas com todos os miRs avaliados ressaltaram este mesmo grupo de miRs entre os mais significativamente correlacionados, além de outros 73 correlacionados com a parasitemia, 67 com o intervalo QTc e 16 com ambos os parâmetros simultaneamente. Nas análises in silico, TNF-alfa e ciclina-D1 foram moléculas nodais recorrentes nas redes criadas com alvos dos miRs diferencialmente expressos em todos os tempos avaliados. Na única rede criada com os miRs correlacionados às alterações na parasitemia e intervalo QTc, TNF-alfa, TGF-beta, Rac1 e Src foram as moléculas nodais. Este trabalho apresenta de maneira inédita o envolvimento dos miRs durante a infecção aguda por T. cruzi, proporcionando novas perspectivas em relação a potenciais ferramentas terapêuticas e prognósticas / Chagas disease is a chronic illness caused by infection with the protozoan Trypanosoma cruzi (T. cruzi). Its main clinical outcome is the development of chronic Chagas cardiomyopathy (CCC), which affects 30% of the patients. The factors that define the progression to CCC or maintenance in the asymptomatic indeterminate form of the disease are still poorly understood. Several studies have presented changes occurred in the gene and proteomic expression profiles in both acute and chronic phases of experimental and human Chagas disease. Such changes result from regulation established at different stages of gene expression and may be relevant for the disease prognosis. In this context, microRNAs (miRs) may play an important regulatory function. miRs act by association to a target messenger RNA (mRNA), inhibiting translation or degrading the transcript. Thus, our hypothesis is that acute infection by T. cruzi modulates the expression of microRNAs in the myocardium of mice. The miR expression profile was evaluated by qRT-PCR 15, 30 or 45 days after the infection. This profile was sufficient to segregate the samples according to the time of infection. The number of differentially expressed miRs was higher as the infection progressed. Moreover, six miRs had their expression correlated with worsening of parasitaemia and QTc interval: miR-142-3p miR-142- 5p, miR-145, miR-146b, miR-149 and miR-21. Secondary unbiased correlation analyses showed this cluster of miRs among the most significant and other 73 miRs correlated with parasitaemia, 67 with QTc and 16 with both parameters simultaneously. In silico target prediction analyses showed TNF-alfa and cyclin-D1 as recurrent nodal molecules of the networks created with miRs targets from all time points. The network generated with miRs correlated to changes in parasitaemia and QTc interval showed TNF-alfa, TGF-beta, Rac1 and Src as nodal molecules. This work points out for the first time the involvement of miRs in the acute infection by T. cruzi, providing new insights about potential diagnostic and prognostic tools

O tempo para 1,0mm de depressão do segmento ST (T-1,0mm) adotado para caracterizar o fenômeno do aquecimento, uma expressão do precondicionamento isquêmico (PCI), em testes ergométricos sequenciais é consistente e reprodutível, porém, possui várias limitações. O objetivo deste estudo foi aplicar um escore eletrocardiográfico de isquemia miocárdica em testes ergométricos sequenciais comparando com o clássico índice T-1,0mm. Avaliamos 61 pacientes, com idade média de 62,2+7,5 anos, 86,9% homens, portadores de diabetes mellitus tipo 2 e coronariopatia multiarterial. Foram analisados 151 exames, destes 116 de pacientes completaram as duas fases de avaliação. A primeira fase compreendia dois testes ergométricos sequenciais para documentação do PCI e a segunda fase, após 1 semana, mais dois testes sob efeito de repaglinida oral. Dois observadores aplicaram o escore de forma cega. Observou-se concordância perfeita inter e intraobservador (Kendall Tau-b = 0,96, p<0,0001, Kendall Tau-b=0,98, p<0,0001, respectivamente). Os valores de sensibilidade, especificidade, valor preditivo negativo, valor preditivo positivo e acurácia, foram respectivamente de 72,41%, 89,29%, 75,8%, 87,5% e 81%. Concluímos que o escore de isquemia é um método consistente e reprodutível para documentação do fenômeno do aquecimento, representando uma alternativa factível ao índice T-1,0mm. / The time to 1.0mm ST-segment depression (T-1.0mm), adopted to document the warm-up phenomenon, an expression of the ischemic preconditioning (IPC), during sequential exercise tests is considered reliable and reproductible, although with several limitations. The main goal of this study was to apply an electrocardiographic ischemic myocardium score to sequential exercise tests, comparing with the standard T-1.0mm. We evaluated 61 patients, mean age 62,2+7,5 years-old, 86.9% male, with type 2 diabetes mellitus and multivessel coronary disease. We analyzed 151 exercise tests, being 116 tests from patients who fulfilled the two phases of the study. The first phase enrolled the patients for two sequential exercise tests to document the IPC and the second phase, after 1 week, two additional sequential exercise tests were performed under repaglinide treatment. We observed a perfect concordance inter and intraobserver (Kendall Tau-b=0.96, p<0.0001; Kendall Tau-b=0,98, p<0,0001, respectively). The sensibility, specificity, positive predictive value and negative predictive value were also determined: 72.41%, 89.29%, 75.8%, 87.5% and 81%, respectively. In conclusion, the electrocardiographic ischemic score is a consistent and reproductible tool to document the warm-up phenomenon, representing a reliable alternative to the T-1.0mm.

No description available.

<p>This study evaluated the use of multi-lead ST-monitoring in the early assessment of patients with suspected or confirmed unstable coronary artery disease (UCAD).</p><p>At continuous 12-lead ECG (c12ECG), the definition of an ischemic episode as a transient ST-deviation ¡Ý0 for at least 1 minute resulted in a good observer agreement (kappa=0.72) and an acceptable incidence of postural ST-changes.</p><p>When c12ECG was performed from admission and for 12 hours in 630 patients with suspected UCAD, 16% had ischemic episodes. At 30 days, patients with episodes had a higher risk of cardiac death or myocardial infarction (MI) (10% vs. 1.5%). In a multivariate analysis, troponin T¡Ý0.10¦Ìg/l and presence of ischemic episodes were independent predictors of cardiac death or MI. When ST-monitoring and troponin T status were combined, patients could be divided into a low-, intermediate-, and high-risk group with 1%, 4% and 12% risk for cardiac death or MI at 30 days of follow up.</p><p>As a part of a multicenter trial, including patients with UCAD, 1016 patients underwent ST-monitoring with c12ECG or continuous vectorcardiography (cVCG). Ischemia was detected in 32% and 35%, respectively. When the groups with ischemia were compared, the groups were similar with respect to several clinical variables. Thus, these methods identify the same high-risk population.</p><p>Of the 629 patients treated non-invasively with extended treatment of low-molecular- weight heparin (LMWH) or placebo, 34% had ischemic episodes. In this group at 3 months, patients administered LMWH had a significantly lower risk of death, MI, or revascularization than patients treated with placebo (35.2% vs. 53.4%). In patients without transient ischemic episodes, the outcome in the LMWH and placebo group was similar.</p><p>Thus, multi-lead monitoring provides important prognostic information early after admission in this population, and seems to identify patients who benefit most from extended antithrombotic treatment.</p>

<p>Reduced performance of the left ventricle to eject blood – left ventricular systolic dysfunction (LVSD) – is a common predecessor of the heart failure syndrome. With or without symptoms, LVSD is associated with a poor prognosis. However, with adequate treatment, the development or progression of symptoms, the need for hospitalisation and mortality can all be reduced. In the present work, the occurrence of LVSD was evaluated by echocardiography in a community-based sample of 75-year-old men and women (n = 433). LVSD was a common condition, with a prevalence rate of 6.8%. In nearly half the participants with LVSD, there was no clinical evidence of heart failure.</p><p>Community-based screening for asymptomatic LVSD has been proposed as a strategy to reduce the incidence of heart failure. Because of the high costs and low availability, echocardiography is not a suitable screening tool. The plasma concentration of B-type natriuretic peptide (BNP) has been the most advocated screening tool. Another alternative is the standard 12-lead electrocardiogram (ECG). Both the ECG and BNP were effective in excluding LVSD in our 75-year-old community-based sample. However, compared with BNP, the ECG had considerably better specificity. In screening for LVSD, BNP had a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.</p><p>The left ventricular ejection fraction (LVEF) measured by echocardiography is a well-established index for describing left ventricular systolic function. The wall motion index (WMI) and the amplitude of mitral annulus motion (MAM) are suggested as alternative echocardiographic methods. Compared with MAM, the WMI had a more favourable agreement with the LVEF in our 75-year-old participants. Nonetheless, MAM was a strong predictor of mortality. MAM predicted the risk of all-cause and cardiac mortality independently of other risk factors. In addition, when it came to cardiac mortality, the predictive ability of MAM was independent of the LV function measured as the WMI.</p>

This study evaluated the use of multi-lead ST-monitoring in the early assessment of patients with suspected or confirmed unstable coronary artery disease (UCAD). At continuous 12-lead ECG (c12ECG), the definition of an ischemic episode as a transient ST-deviation ¡Ý0 for at least 1 minute resulted in a good observer agreement (kappa=0.72) and an acceptable incidence of postural ST-changes. When c12ECG was performed from admission and for 12 hours in 630 patients with suspected UCAD, 16% had ischemic episodes. At 30 days, patients with episodes had a higher risk of cardiac death or myocardial infarction (MI) (10% vs. 1.5%). In a multivariate analysis, troponin T¡Ý0.10¦Ìg/l and presence of ischemic episodes were independent predictors of cardiac death or MI. When ST-monitoring and troponin T status were combined, patients could be divided into a low-, intermediate-, and high-risk group with 1%, 4% and 12% risk for cardiac death or MI at 30 days of follow up. As a part of a multicenter trial, including patients with UCAD, 1016 patients underwent ST-monitoring with c12ECG or continuous vectorcardiography (cVCG). Ischemia was detected in 32% and 35%, respectively. When the groups with ischemia were compared, the groups were similar with respect to several clinical variables. Thus, these methods identify the same high-risk population. Of the 629 patients treated non-invasively with extended treatment of low-molecular- weight heparin (LMWH) or placebo, 34% had ischemic episodes. In this group at 3 months, patients administered LMWH had a significantly lower risk of death, MI, or revascularization than patients treated with placebo (35.2% vs. 53.4%). In patients without transient ischemic episodes, the outcome in the LMWH and placebo group was similar. Thus, multi-lead monitoring provides important prognostic information early after admission in this population, and seems to identify patients who benefit most from extended antithrombotic treatment.