Ischemic heart disease (IHD) is one of leading morbidity and mortality caused worldwide. Along with medical treatment currently there are two main methods of coronary revascularisation – percutaneous coronary intervention (PCI) and aortocoronary bypass surgery (ACBS). New heart revascularisation methods are under development, which are to be applied for routine practice in the future. One of methods stimulating angiogenesis is cardiac shock wave therapy (CSWT). CSWT is new reconstructive / regeneration treatment method offering alternative for revascularisation, as use of steam cells for such purposes is still in the stage of trials. Low frequency mechanical waves are used for CSWT. Their effect results in improved heart perfusion and development of blood vessels' network. Such waves for the first time in medicine were applied about 20 years ago for renal stones fragmentation. This treatment method has been recently applied in clinics worldwide and only few of them obtained some experience in this area. CSWT, along with medical and invasive treatment methods for patients with severely advanced ischemic heart disease, in Santariškių Clinics of Vilnius University Hospital was introduced in 2008. / MSBT– tai naujas atkuriamojo/ regeneracinio gydymo būdas, galintis tapti revaskuliarizacijos alternatyva, nes kamieninių ląstelių pritaikymas tokiais tikslais tebėra tiriamas. MSBT metu naudojamos žemo dažnio mechaninės bangos, kurioms veikiant, pagerinama širdies perfuzija ir sukuriamas kraujagyslių tinklas. Tokios bangos pirmą kartą medicinoje buvo pritaikytos inkstų akmenims skaldyti maždaug prieš 20 metų . MSBT tyrimai pradėti atlikti su pacientais, kuriems diagnozuota labai pažengusi išeminė širdies liga, lydima III−IV klasės krūtinės anginos(KA) pagal Kanados klasifikaciją (CCS), yra trijų vainikinių arterijų liga, kartais su kairės vainikinės arterijos kamieno stenoze. Šiems pacientams anksčiau atliktos angioplastikos ir stentavimo procedūros arba viena ar kelios aortokoronarinių jungčių suformavimo operacijos, tačiau KA atsinaujino, todėl nuolatos skiriamos maksimalios toleruojamos nitratų dozės. Tačiau krūtinės anginos epizodai kartojasi kelis kartus per dieną minimalaus fizinio krūvio metu ar net ramybėje. Pasaulyje šis gydymo metodas tik pradedamas taikyti ir pirminės patirties sukaupta tik nedaugelyje klinikų. Iki 2008m. VUL Santariškių klinikose išemine širdies liga (IŠL) sergantys pacientai buvo gydomi standartiniais metodais: medikamentais, PKI ir vainikinių arterijų apeinamųjų jungčių suformavimo operacija. 2008 m. Vilniaus universiteto ligoninės Santariškių klinikose labai pažengusia išemine širdies liga sergančių pacientų gydymui, be medikamentinio ir... [toliau žr. visą tekstą]

MSBT– tai naujas atkuriamojo/ regeneracinio gydymo būdas, galintis tapti revaskuliarizacijos alternatyva, nes kamieninių ląstelių pritaikymas tokiais tikslais tebėra tiriamas. MSBT metu naudojamos žemo dažnio mechaninės bangos, kurioms veikiant, pagerinama širdies perfuzija ir sukuriamas kraujagyslių tinklas. Tokios bangos pirmą kartą medicinoje buvo pritaikytos inkstų akmenims skaldyti maždaug prieš 20 metų . MSBT tyrimai pradėti atlikti su pacientais, kuriems diagnozuota labai pažengusi išeminė širdies liga, lydima III−IV klasės krūtinės anginos(KA) pagal Kanados klasifikaciją (CCS), yra trijų vainikinių arterijų liga, kartais su kairės vainikinės arterijos kamieno stenoze. Šiems pacientams anksčiau atliktos angioplastikos ir stentavimo procedūros arba viena ar kelios aortokoronarinių jungčių suformavimo operacijos, tačiau KA atsinaujino, todėl nuolatos skiriamos maksimalios toleruojamos nitratų dozės. Tačiau krūtinės anginos epizodai kartojasi kelis kartus per dieną minimalaus fizinio krūvio metu ar net ramybėje. Pasaulyje šis gydymo metodas tik pradedamas taikyti ir pirminės patirties sukaupta tik nedaugelyje klinikų. Iki 2008m. VUL Santariškių klinikose išemine širdies liga (IŠL) sergantys pacientai buvo gydomi standartiniais metodais: medikamentais, PKI ir vainikinių arterijų apeinamųjų jungčių suformavimo operacija. 2008 m. Vilniaus universiteto ligoninės Santariškių klinikose labai pažengusia išemine širdies liga sergančių pacientų gydymui, be medikamentinio ir... [toliau žr. visą tekstą] / Ischemic heart disease (IHD) is one of leading morbidity and mortality caused worldwide. Along with medical treatment currently there are two main methods of coronary revascularisation – percutaneous coronary intervention (PCI) and aortocoronary bypass surgery (ACBS). New heart revascularisation methods are under development, which are to be applied for routine practice in the future. One of methods stimulating angiogenesis is cardiac shock wave therapy (CSWT). CSWT is new reconstructive / regeneration treatment method offering alternative for revascularisation, as use of steam cells for such purposes is still in the stage of trials. Low frequency mechanical waves are used for CSWT. Their effect results in improved heart perfusion and development of blood vessels' network. Such waves for the first time in medicine were applied about 20 years ago for renal stones fragmentation. This treatment method has been recently applied in clinics worldwide and only few of them obtained some experience in this area. CSWT, along with medical and invasive treatment methods for patients with severely advanced ischemic heart disease, in Santariškių Clinics of Vilnius University Hospital was introduced in 2008.

Darbo uždaviniai: 1. Nustatyti pradinės AGDD paplitimą vidutinio amžiaus (40 – 64 metų) pacientų, sergančių IŠL grupėje bei atsitiktinėje to paties amžiaus Kauno miesto gyventojų imtyje. 2. Palyginti pacientų, sergančių tik IŠL ir IŠL bei pradinės AGDD klinikinius duomenis. 3. Nustatyti MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T) genotipų dažnį bei genotipų derinių įtaką AGDD susiformavimui. 4. Nustatyti MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T) genotipų dažnį esant minkštoms ir kietoms drūzoms, sergant AGDD. 5. Nustatyti MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T) genotipų dažnį bei genotipų derinių įtaką AGDD ir IŠL drauge bei tik IŠL pasireiškimui. 6. Nustatyti funkcinio kontrastinio jautrumo tyrimo rodmenis pacientams, sergantiems pradine lengva ir pradine vidutine AGDD bei spalvų juslės pokyčius sergantiems pradine AGDD, ir oftalmologiškai sveikiems pacientams. / The goals were as follows: 1. To determine the prevalence of AMD in patients with IHD and compare with the prevalence in a random sample of Kaunas population (at 40-64 yrs old). 2. To compare the main clinical characteristics of the patients exhibiting early AMD and IHD together with the patients with IHD alone. 3. To determine the frequency of the genotypes of the matrix metalloproteinases (MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T)), and genotype combinations that have an influence on the development of early AMD. 4. To determine the frequency of the genotypes of the matrix metallo¬proteinases (MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T)), in early AMD patients with soft or hard drusen. 5. To determine the frequency of the genotypes of the matrix metallo¬proteinases (MMP-2 (-735 C/T), MMP-2 (-1306 C/T), MMP-3 (-1171 5A/6A), MMP-9 (-1562 C/T)), and the influence of genotype combi¬na¬tions on the development of AMD and IHD together, and only on IHD development. 6. To determine the results of functional acuity contrast sensitivity test in patients with early mild and early intermediate AMD, and color contrast sensitivity in patients with AMD, and in ophthalmologically healthy patients.

Ischemic heart disease belongs to the most frequent diseases in developed countries. I have chosen this topic not only because I am interested in this issue but also because I work at emergency ward of internal medicine and majority of patients there suffer from this disease. There are two parts in my thesis {--} the theoretical and the research part. The theoretical part deals with heart anatomy and physiology, with epidemiology and aetiology, with risk factors, with classification, clinical picture, diagnostics, with treatment and prevention of ischemic heart disease. Further, the thesis survey educational process, roles, mission, function and competences of a nurse. The first objective of the thesis was to find out the awareness of nurses´ competences in the area of secondary preventive care in patients with ischemic heart disease. The second objective was to find out, whether nurses are able to apply their competences in the area of secondary preventive care in patients with ischemic heart disease. The third objective was to find out involvement of management (head nurses, departmental nurses, shift nurses) in the secondary preventive care in patients with ischemic heart disease. The fourth objective of the thesis was to find out whether nurses use their knowledge of secondary prevention in patients with ischemic heart disease. Four hypotheses were set for the above mentioned objectives. H1: Nurses are aware of their competences in the area of secondary preventive care in patients with IHD. H2: Nurses are able to apply their competences in the area of secondary preventive care in patients with IHD. H3: Shift nurses, motivated by head nurses, are more involved in the secondary prevention in patients with IHD. H4: Nurses use their knowledge in the area of secondary prevention in patients with IHD. A questionnaire was made up to achieve the objectives and to prove or to disprove the hypotheses of this research. The questionnaire contained 24 questions {--} closed and semi-closed. The research sample was formed from nurses from South Bohemian and central-Bohemian regions. 377 questionnaires were handed out. 242 questionnaires returned and 230 of them were applicable to the research. The first, second and fourth hypotheses were proved. Shift nurses are more involved in secondary prevention in patients with IHD, however, not on the basis of motivation by head nurses, thus, the fourth hypothesis was not proved. I also revealed that nurses do not have sufficient knowledge in the area of secondary preventive care in patients with IHD. On the grounds of these results we created mental maps on ischemic heart disease and its prevention. These maps might enhance nurses´ knowledge and improve the life of patients with ischemic heart disease.

nÃo hà / As doenÃas cardiovasculares, incluindo a cardiopatia isquÃmica aterosclerÃtica, sÃo a princi-pal causa de morte no Brasil. A aterosclerose à doenÃa inflamatÃria crÃnica que se inicia na infÃncia, progride lentamente e se expressa dÃcadas depois. Ela principia por disfunÃÃo do endotÃlio, tem patogÃnese multifatorial e tem, como principais fatores de risco, o sexo mascu-lino, a idade, o tabagismo, a hipercolesterolemia, a hipertensÃo arterial sistÃmica (HAS), o diabetes mellitus (DM) e o antecedente familiar de doenÃa aterosclerÃtica precoce. A elevaÃÃo de vÃrios marcadores bioquÃmicos sinaliza a participaÃÃo da inflamaÃÃo na aterosclerose. O peptÃdeo natriurÃtico tipo B e o fragmento amino-terminal do pro-peptÃdeo natriurÃtico tipo B (NT-proBNP) tambÃm aumentam na aterosclerose coronÃria. Esse trabalho à um estudo ob-servacional, transversal, de uma sÃrie consecutiva de 153 pacientes internados na Enfermaria de Cardiologia do HUWC-UFC, no perÃodo de 01.08.2007 a 31.03.2008, com hipÃtese diag-nÃstica de cardiopatia isquÃmica â angina estÃvel (AE), angina instÃvel (AI) ou infarto agudo do miocÃrdio (IAM) â submetidos à cineangiocoronariografia, comparando-se o grupo porta-dor de obstruÃÃo aterosclerÃtica coronÃria angiogrÃfica (grupo A) com aquele de artÃrias co-ronÃrias angiograficamente normais (grupo B). Os critÃrios de exclusÃo foram revasculariza-ÃÃo miocÃrdica prÃvia â cirÃrgica ou percutÃnea â insuficiÃncia renal dialÃtica aguda ou crÃni-ca, neoplasia maligna, infecÃÃo, doenÃa inflamatÃria aguda ou crÃnica, doenÃa pulmonar, he-pÃtica ou hematolÃgica e cardiopatia valvar, congÃnita ou cardiomiopatia associada. Ambos os grupos foram analisados, de modo semelhante, quanto ao sexo, à idade, à escolaridade, ao Ãndice de massa corporal (IMC), à circunferÃncia abdominal (CA), ao tabagismo, ao DM, à HAS, à histÃria familiar positiva para aterosclerose precoce, ao uso de estatina, à presenÃa de sÃndrome metabÃlica (SM) e à apresentaÃÃo clÃnica como AE, AI ou IAM. Eles tambÃm fo-ram analisados em relaÃÃo ao eletrocardiograma, à radiografia do tÃrax e ao ecocardiograma, quanto à presenÃa ou nÃo de disfunÃÃo sistÃlica; ao colesterol nÃo-HDL, à HDL-colesterol, à relaÃÃo do colesterol total / HDL-colesterol < 5 e do LDL-colesterol / HDL-colesterol < 3,5; à creatinina e o ao fibrinogÃnio, ao nÃmero de leucÃcitos totais e ao de monÃcitos, à proteÃna C reativa ultra-sensÃvel e ao NT-proBNP. A comparaÃÃo dos dois grupos revelou, com signifi-cÃncia estatÃstica, à anÃlise univariada, que os pacientes do grupo A tinham prevalÃncia maior de DM e de disfunÃÃo sistÃlica, NT-proBNP &#8805; 250 pg/ml, fibrinogÃnio acima de 500 mg/dl; mais frequentemente usavam estatina e tinham monÃcitos 501 ou mais por mm3 do que aque-les do grupo B. Curiosamente, o IMC &#8805; 30 e a CA aumentada foram mais prevalentes no gru-po com artÃrias coronÃrias normais. No entanto, pela regressÃo logÃstica multivariada, os fato-res independentes para oclusÃo aterosclerÃtica coronariana angiogrÃfica foram o NT-proBNP &#8805; 250 pg/ml, o DM e o aumento do fibrinogÃnio e dos monÃcitos, mesmo consideradas a creatinina e a disfunÃÃo sistÃlica. Na amostra estudada, o modelo com ajuste de prevalÃncia desses fatores teve sensibilidade de 80,4%, especificidade de 76,9 e 79,7% de acurÃcia para o diagnÃstico de oclusÃo coronariana aterosclerÃtica angiogrÃfica. / Cardiovascular diseases, including ischemic heart disease, are the main causes of death in Brazil. Atherosclerosis is a chronic inflammatory disease that starts in the childhood, progresses slowly and shows up many decades later. It begins as an endothelial dysfunction and has as its main risk factors the male sex, age, smoking, hypercholesterolemia, arterial hypertension, diabetes mellitus and a background of early family atherosclerotic disease. The rise of many biochemical markers in the plasma signals the presence of inflammation in the atherosclerosis. The brain natriuretic peptide and the amino-terminal pro-B-type natriuretic peptide (NT-proBNP) also increase in coronary atherosclerosis. This is a cross-sectional and observational study of 153 in-patients at the Cardiology Ward of HUWC-UFC from 08.01.2007 to 03.31.2008 with the diagnostic hypothesis of Ischemic Heart Disease, i.e., stable angina, unstable angina or acute myocardial infarction. All of them underwent heart catheterization and coronary angiography. They were classified respectively as group A or B in accordance with the presence or not of angiographic atherosclerotic coronary occlusion. Patients were not included in the analysis if they had been submitted to surgical or percutaneous revascularization; had an acute or chronic dialytic kidney disease; cancer or infection; a lung, hepatic or hematopoietic disease; an acute or chronic inflammatory illness or associated myocardial, valvular or congenital heart disease. The two groups were analyzed in a similar way with regard to gender, age, level of education, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, an early atherosclerosis family history, the use of statin, presence of metabolic syndrome and clinical presentation of stable angina, unstable angina or acute myocardial infarction. The HDL-cholesterol, non HDL-cholesterol, a total cholesterol/HDL-cholesterol ratio < 5, a LDL-cholesterol/HDL-cholesterol ratio < 3.5, the creatinine and fibrinogen plasma concentration, the total leukocyte and monocyte count, the high-sensitivity C reactive protein, the NT-proBNP, the electrocardiogram, the chest radiography and the echocardiogram, with regard to the presence or not of systolic dysfunction, were also analyzed. The univariety analysis comparing both groups revealed that group Aâ patients more frequently were diabetics and had systolic dysfunction, NT-proBNP &#8805; 250 pg/ml, fibrinogen higher than 500 mg/dl, more frequent use of statin and 501 or more monocytes/mm3 than patients group B. Curiously, the body mass index &#8805; 30 and abnormal abdominal circumference were more frequently found among patients with angiographic normal coronary arteries. Nevertheless, by multivariety regression logistic analysis the independent factors for angiographic atherosclerotic coronary occlusion were the NT-proBNP &#8805; 250 pg/ml, diabetes mellitus, an increase of monocyte number and of fibrinogen plasma concentration, in spite of creatinine level and presence of systolic dysfunction. The model takes into account these factors has 80.4% sensitivity, 76.9% specificity and 79.7% of accuracy for the diagnostic of angiographic atherosclerotic coronary occlusion.

Orientador: Roberta Cunha Matheus Rodrigues / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas. / Made available in DSpace on 2018-08-21T02:54:08Z (GMT). No. of bitstreams: 1 Mendez_RobertoDellaRosa_D.pdf: 2184644 bytes, checksum: e6d010e46d506b5233f057f622eec884 (MD5) Previous issue date: 2012 / Resumo: O objetivo deste estudo foi examinar o efeito de intervenção motivacional baseada em teoria (Programa Caminhar) para promover o comportamento de caminhada entre pacientes com doença arterial coronária (DAC), por meio do fortalecimento dos determinantes psicossociais do comportamento, especificamente a atitude e o controle comportamental percebido. Um total de 84 pacientes foram randomizados nos grupos Intervenção (GI; n=44) e Controle (GC; n=40). Trata-se de estudo experimental, randomizado, realizado em três etapas. Na abordagem inicial (T0) foram obtidas as variáveis sociodemográficas, clínicas, comportamentais - medida autorrelatada da frequência de caminhada (derivada do Questionário para identificação dos fatores psicossociais determinantes do comportamento de atividade física em coronariopatas - QCAF), medida da capacidade física limitada por sintomas (Veterans Specific Activity Questionnaire - VSAQ) e a medida objetiva do comportamento de realizar a caminhada, estimada pelo número de passos (pedômetro). Foram também avaliadas as variáveis psicossociais - intenção, atitude, controle comportamental percebido e autoeficácia. Uma semana após a abordagem inicial (T1s), os pacientes do GI retornaram para as sessões de intervenção. A prática guiada e a comunicação persuasiva foram os métodos derivados de teorias utilizados para fortalecer a atitude e o controle comportamental percebido, respectivamente. O reforço da estratégia persuasiva entre os participantes do GI ocorreu pelo envio semanal de mensagens pelo correio. Os participantes do GC receberam os cuidados usuais oferecidos pelo serviço de saúde. Após dois meses (T2) foram obtidas novas medidas das variáveis comportamentais e psicossociais, em ambos os grupos. Os dados foram analisados por meio de análises descritivas e de comparação. Análises de regressão foram realizadas para verificar o efeito da intervenção no comportamento e na intenção. O tamanho do efeito (effect size) foi calculado para estimar a magnitude do efeito da intervenção. Os resultados evidenciaram aumento significativo do comportamento autorrelatado de caminhada no GI, comparado ao GC (d=0,89). A intervenção explicou 36,4% da variabilidade desta medida, embora não tenha explicado as mudanças na capacidade física autorrelatada, na medida objetiva do comportamento e nas variáveis psicossociais. A intervenção baseada na combinação dos métodos de comunicação persuasiva e prática guiada foi efetiva para promover o comportamento de caminhada entre pacientes com DAC. Recomenda-se a realização de novos estudos com períodos mais longos de seguimento e emprego de medida ouro para avaliação objetiva da atividade física com vistas a ratificar o efeito da intervenção na promoção de estilo de vida ativo / Abstract: This aimed of this study was to examine the effect of motivational intervention based on the theory (Walking Program) to promote walking behavior among patients with coronary heart disease (CAD), through the strengthening of psychosocial determinants of behavior, specifically the attitude and behavioral control perceived. A total of 84 patients were randomized into intervention groups (GI, n = 44) and control (CG, n = 40). This is a randomized experimental study with three stages. In the initial (T0) were obtained sociodemographic, clinical, behavioral - as self-reported frequency of walking (derived from the questionnaire to identify the psychosocial determinants of physical activity behavior in coronary patients - QCAF), measurement of physical capacity limited by symptoms (Veterans Specific Activity Questionnaire - VSAQ) and objective measure of behavior to make the walk, estimated by the number of steps (pedometer). We also assessed the psychosocial variables - intention, attitude, perceived behavioral control and self-efficacy. One week after the initial approach (T1s), the patients returned to the GI intervention sessions. The guided practice and persuasive communication methods were derived from theories used to strengthen the attitude and perceived behavioral control, respectively. Strengthening the persuasive strategy among the participants of GI occurred by persuasive messages sent weekly by mail. Participants in the CG received usual care offered by the health service. After two months (T2) were obtained new measures of behavioral and psychosocial variables in both groups. The data form analyzed using descriptive analysis and comparison. Regression analyzes were performed to determine the effect of the intervention on behavior and intention. The size effect (effect size) was calculated to estimate the magnitude of the effect of the intervention. The results showed significant increase in self-reported walking behavior in the IG compared to CG (d = 0.89). The intervention explained 36.4% of the variability of this measure, although it failed to explain the changes in physical self-reported, the objective measurement of behavior and psychosocial variables. The intervention based on a combination of methods of persuasive communication and guided practice was effective in promoting walking behavior among patients with CAD. It is recommended that further studies with longer periods of follow-up and use of gold as an objective assessment of physical activity to ratify the effect of intervention in promoting active lifestyles / Doutorado / Enfermagem e Trabalho / Doutor em Enfermagem

Patients with rheumatoid arthritis (RA) have a shorter life span than the general population. An increased death due to cardiovascular disease (CVD) has been reported. RA is characterized by synovitis and joint destruction accompanied by an acute phase reaction and systemic features. The present work investigates the epidemiology of CVD in patients with RA in the county of Västerbotten and the influence of inflammation on lipid metabolism and haemostasis. In a retrospective cohort study on 606 RA patients, the overall mortality was significantly higher than in the general population, with an excess death rate for CVD and for ishemic heart diseae (IHD) in both sexes. Multiple Cox regression, showed that male sex, higher age at disease onset and cardiovascular event increased the risk for death. Male sex, high age at disease onset and hypertension increased the risk for cardiovascular event. Diabetes mellitus, treatment with corticosteroids, disease modifying antirheumatic drugs and postmenopausal estrogen neither influenced survival nor the risk of cardiovascular event. In 93 patients with active RA, the levels of cholesterol, high density- (HDL) and low density (LDL) lipoprotein cholesterol were significantly lower, and Lipoprotein(a) was significantly higher compared to controls. In a follow-up on 53 patients, a relation between the change of Lp(a) and acute phase proteins was found only in patients with high levels of Lp(a). Preheparin lipoprotein lipase (LPL) activity and mass were significantly decreased in 17 postmenopausal women with active RA. Preheparin LPL mass correlated inversely to several acute phase proteins and interleukin-6. Low levels of LPL mass may implicate increased hepatic clearence but also increased macrophage ingestion of lipoproteins via the LDL receptor-related protein (LRP). Haemostasis of the circulation was investigated in 74 of the 93 patients with active RA. In patients with extraarticular disease, the release of tissue plasminogen activator (tPA) was significantly decreased, and its inhibitor (PAI-1) was significantly increased compared to patients with nonsystemic disease, implicating hypofibrinolysis. In a two year follow-up, patients with thromboembolic events had significantly elevated levels of von Willebrand factor, PAI-1, triglycerides and haptoglobin compared to event-free patients. In 29 RA patients and 18 spondylarthropathy patients with gonarthritis, radiological joint destruction correlated to PAI-1 antigen in synovial fluid and, inversely, to plasminogen. A relationship between activation of fibrin degrading proteolytic enzymes and joint destruction was implicated. In conclusion, several processes involved in lipid metabolism and haemostasis are influenced in active RA. In view of the increased death rate due to CVD, an efficient control of inflammation should be important, not only for reducing joint destruction, but also for reducing systemical atherogenic and thrombogenic effects. / <p>s. 1-54: sammanfattning, s. 55-133: 6 uppsatser</p> / digitalisering@umu.se

Purpose of Review: This article reviews the evidence on optimal medical therapy (OMT) versus coronary revascularization in patients with stable ischemic heart disease (SIHD) and advanced chronic kidney disease (CKD). Recent Findings: A post hoc analysis of the COURAGE trial in patients with SIHD and CKD showed no difference in freedom from angina, death, and nonfatal myocardial infarction (MI) between OMT and percutaneous intervention plus OMT compared with patients without CKD. The ISCHEMIA-CKD trial of 777 patients with advanced CKD revealed no difference in cumulative incidence of death or nonfatal MI at 3 years between OMT and revascularization but the composite of death or new dialysis was higher in the invasive arm. Additionally, there were no significant or sustained benefits in related to angina-related health status in invasive versus conservative strategy. Summary: An initial revascularization strategy does not reduce mortality or MI or relieve angina symptoms in patients with SIHD and advanced CKD.

Disertacijos objektas yra koronarine širdies liga ir ryškiai sumažinta kairiojo skilvelio sistoline funkcija sergančių ligonių klinikinės būklės pokyčiai ir išgyvenimas vėlyvuoju pooperaciniu laikotarpiu po izoliuotų aorto-vainikinių arterijų apeinamųjų jungčių suformavimo operacijų (AVAJSO), bei kairio skilvelio tūrio ir formos atkūrimo operacijų (TFAO). Tai retrospektyvinis tyrimas. Analizuoti 216 ligonių sergančių koronarine širdies liga, kuriems atliktos AVAJSO ir 139 ligonių, kuriems kartu su revaskuliarizacija atliktos kairio skilvelio TFAO, duomenys. Nustatyta, kad ligonių, sergančių IŠL su KS sistoline disfunkcija, išgyvenimas vėlyvuoju – iki 7 metų laikotarpiu po AVAJSO bei 6 metų laikotarpiu po KS TFAO, yra geras. Nustatėme, kad operacijų, kurias nuspręsta atlikti ligoniams, turintiems krūtinės anginos simptomus, be miokardo gyvybingumo požymių įrodymo echokardiografiniu mažų dozių dobutamino krūvio mėginiu, pirmųjų 30 parų mirties rizika nebuvo didesnė. Rasta, kad ligonių, kurių funkcinė klasė vienerių metų laikotarpiu po AVAJSO buvo blogesnė, iki operacijos buvo EKG ilgesnė QRS komplekso trukmė, didesni KS galiniai diastoliniai dydžiai ir operacijos metu jiems buvo suformuota mažiau AVA jungčių. Išaiškinta, kad KS tūrio ir formos atkūrimo operacijos ligoniams su toli pažengusia KS remodeliacija atliekamos saugiai, su ne didesne pirmųjų 30 parų mirties rizika nei atliekant vien AVAJSO. Išaiškinta, kad tų ligonių, kurių funkcinė būklė nepagerėjo vienerių metų... [toliau žr. visą tekstą] / ANNOTATION OF DISERTATION Subject of disertation: Surgical treatment of patients suffering from ischemic heart disease with significantly decreased left ventricle systolic function: clinical evaluation. Objective - evaluation of clinical status and long-term postoperative survival of patients suffering from ischemic heart disease and decreased left ventricle systolic function (LV EF ≤ 35%) after isolated coronary by-pass grafting and left ventricle volume and shape surgical restoration operations. Retrospective study. The study group included 216 patients for whom coronary artery bypass grafting (CABG) and 139 patients who underwent surgical ventricular restoration (SVR). It was postulated that the long-term survival (up to 7 years) in patients after CABG and long-term survival (6 years) in patients after SVR is good. It was found out that the risk of fatal outcome during the first 30 days after CABG in patients 0suffering from ischemic LV dysfunction and symptoms of angina pectoris with viable myocardium, statistically reliably did not differ from patients with nonviable myocardium. It was stated that patients with greater functional class during one year after CABG, preoperatively had longer duration of ECG QRS complex, higher end-diastolic findings and had lower number of by-passes during the operation. We also demonstrated that LV shape and volume restoration operations were being performed for patients with highly advanced LV remodeling safely and postoperative risk... [to full text]

<p>The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied.</p><p>The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI.</p><p>Persistent cTnI elevation > 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up. </p><p>These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.</p>