Aim. This study aimed to study the effect of patients’ and physician’s characteristics as a predictor of length of stay (LOS) in patients undergoing coronary bypass surgery.

Material and methods. This was a retrospective study conducted at Tabriz Shaheed Madanee Cardiac Teaching Hospital in Iran in 2010. The 349 patients who did undergo a bypass surgery during 2008–2010 were studied. Patients and physicians characteristic were collected from patients medical records using a researcher developed checklist. Independent Samples Test of ANOVA was conducted to compare LOS between categorical variables. Data was analyzed using the SPSS17 statistical package.

Results. The mean age of the patients was 59.7 years. Overall average LOS was 15.58 (10.02) days. The findings of this study indicate that older patients stayed in the hospital for a significantly longer period than did younger patients. Patients’ stay at the hospital was statistically significant and longer than assessed expected length of stay estimated by physicians (P< 0.05). Patient admitted to the hospital through emergency department and patients with no hospitalization history stayed longer in the hospital (P≤0.01).).Early discharged patients and death cases also had a longer LOS (P ≤ 0.01).Patient whose attending physicians were working in private sector, in addition to Shaheed Madanee Hospital and had higher level of education stayed longer than those whose physicians worked only at Shaheed Madanee Hospital (P≤ 0.01).

Conclusion. Institutional characteristics –physicians practice both in private sector and public teaching hospital, physicians’ level of education, discharge process guidelines, and admission protocols were most important factor in predicting LOS. The patient’s hospitalization history whether patient was hospitalized before or not, was also a predictor.

A 27-year-old patient with Parahisian Wolff-Parkinson-White Syndrome (WPW), who had very frequent tachycardia attacks and pre-syncope complaints, could not be cured with the RF ablation method previously. Since RF ablation may necessitate a permanent cardiac pacemaker, cryoablation was decided to be performed in another session. Herein, we report a successful treatment of a WPW case via cryoablation.

Kounis syndrome is a well-known cause of acute coronary syndrome and more than 100 cases are reported with allergic reactions to various drugs, animal and insect bites, even with drug eluting stents and endovascular devices. In this paper we report five-patients with Kounis syndrome related to different drugs. The main characteristic of patients is given in Table 1. All of them were male and their age was from 18 to 35. All patients presented with ST- elevation myocardial infarction. Coronary angiography was performed in all patients and revealed normal coronary arteries. From history of allergic exposure, electrocardiographic, laboratory (Total IgE and tryptase levels) and angiographic findings the diagnosis was Kounis syndrome type I for all patients and was treated with oral antihistamines and prednisolone. Despite Type 1 KS is not associated with atherosclerotic risk factors and CAD all patients in or report and many patients in literature are male. Gender differences in KS should be investigated in further studies.

In the article the sensitivity of new vectorcardiographic research method of patients on the cardiodiagnostic complex МТМ-SКМ in the process of thrombolytic therapy is proved by clinical example.

Clinical case. In a patient with acute myocardial infarction of anterior wall of the left ventricle vectorcardiogram results give the opportunity to confirm a significant diminution of the area of myocardial damage with concomitant deterioration of conductivity and preserving of ischemic events due to reduction of electromotive force of the heart in the anterior wall of the left ventricle. In addition, the dynamic decrease of the electrical activity of the atria with a significant slowing of the pulse and repolarization disorder may indicate involvement of atriums in the pathological process with a considerable blood flow disorder in them.

Conclusion. This method allows to make a quality and quantitative evaluation of the efficiency of the reperfusion therapy, as well as to obtain the information about the electromotive force of the heart both in the necrobiosis zone and out of myocardium affection zone.

T-wave alternans (TWA) in surface electrocardiograph (ECG) signals has been recognized as a marker of cardiac electrical instability, and is hypothesized to be related with patients at increased risk for ventricular arrhythmias. A novel timedomain TWA hybrid analysis method (HAM) utilizing the correlation method and least squares regression technique is described in this paper. Simulated ECGs containing artificial TWA (cases of absence of TWA and presence of stationary or time-varying or phase-reversal TWA) under different baseline wanderings are used to test the method, and the results shows the HAM has a better ability to quantifying TWA amplitude compared with the Correlation Method (CM) and Adapting Match Filter Method (AMFM). The HAM is subsequently used to analyze the clinical ECGs, and results produced by the HAM have, in general, demonstrated the consistency with those produced by the CM and the AMFM, while the quantifying TWA amplitudes by the HAM are universally higher than those by the other two methods.

Out of many methods used for assessment of physical activity, a questionnaire seems to be a simple and affordable method of assessing the risk of occurrence of coronary insufficiency. However the number of clinical studies done on the application of physical activity questionnaires is limited.

Aim. The objective of the present study was to analyze the suitability of Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) in assessment of physical activity in patients after percutaneous coronary intervention (PCI)

Material and methods. Design: prospective analysis — before and 6 months after PCI and correlation between level of physical activity and physical capacity assessed with treadmill exercise test (ET), ejection fraction (LVEF%) Setting: Upper Silesia Medical Center. Department of cardiology. Population: One hundred fiftieth four inpatients (mean of 56 y), among which there were patients with acute myocardial infarction (MI), with history of past MI and with IHD without MI. All subjects underwent coronarography procedure with optional PCI. All patients underwent phase I and II cardiac rehabilitation. The MLTPAQ was administered to all patients at the time of PCI and then 6 months later, so was the treadmill stress test (TST) and echocardiography (ECHO).

Results. Total energy expenditure calculated with the MLTPAQ remained at the same level and was of low intensity (<4 MET, <2000 kcal/week) 6 months after the PCI. There was an increased physical capacity noted 6 months after initial PCI: increased metabolic cost (MET); maximal oxygen consumption (VO2max); maximal heart rate (HRmax) obtained during the TST and decreased resting heart rate (HRrest). ECHO examination showed improved LVEF%. Clinical Rehabilitation Impact: the helpfulness of the research may be used in the work of cardiologists or physiotherapists. The research will allow to estimate the actual level of physical activity and physical endurance of patients that were treated by angioplasty. Moreover, this is the simple and cheap method of estimation.

Conclusion. Despite increased physical capacity and improved heart hemodynamic resulting most likely from PCI procedure, patients presented with similar level of leisure time physical activity 6 months after the PCI.

Aim. Patients with heart failure have poor prognosis and mortality rate is between 15–60% per year. Implantable cardioverter-defibrillators and cardiac resynchronization therapy have been shown to improve survival, decrease hospital readmissions and mortality, and improve functional status and quality of life in patients with heart failure and left ventricular systolic dysfunction. Aim of the study was to examine the effects of different CRT devices in carefully selected heart failure patients during 1 year.

Material and methods. We included 98 heart failure patients. First group (n=60) received CRT-P, while in second group (n=38) were patients with CRT-D pacemaker (with an additional cardioverter-defibrillator option).

Results. Data gathered in our the study showed that both CRT-P and CRT-D in adequately selected heart failure patients improve different clinical parameters: symptoms, echocardiographic parameters, decrease QRS duration, increase 6 min walk test distance, decrease mortality rate.

Conclusion. Patients with both CRT-P and CRT-D showed improvement in heart failure symptoms and CRT had significant influence on disease prognosis during 1 year of follow up. Nevertheless we do not have the perfect criteria for selection of patients and their follow up after the device implantation. In patients with the rhythm disturbances CRT-D option is the right choice only if the patient has the indications for resynchronization therapy as well. This choice however depends on clinical judgment of the operator more than on strict protocols and guidelines which are necessary but we need more clinical trials to support current hypothesis.

Aim. Benefits of CRT on mortality and morbidity in patients with severe CHF are clear but the effect of CRT on sudden cardiac death is more controversial. It has been suggested that CRT may catalyze arrhythmogenicity by reversing the normal depolarization pattern. The purpose of this study was to examine the effect of CRT on dispersion of repolarization as assessed by ECG. We also sought to determine the value of dispersion of repolarization ECG parameters in predicting the occurrence of major arrhythmic events (MAE) in follow-up.

Material and methods. A total of 48 patients with end-stage heart failure and QRS duration >120 ms underwent CRT. QT dispersion (QTd), T peak t end interval (Tpe) and T peak t end dispersion (Tpe dispersion) were measured before and immediately after CRT implantation. All patients were followed at least 12 months for ventricular tachycardia or fibrillation that were treated with antitachicardia pace or cardioversion.

Results. Over 16±7.1 months, 14 patients had a MAE. Compared to baseline, after CRT, QTc dispersion (84.66±37.7 vs 100.36±47.4, p=0.04) and Tpe interval (104.1±20.4 vs 122.03±33, p=0.02) increased significantly. Increase in QTD (ΔQTD) (31.66±39.5 vs 5.57±5.59, p=0.03), and QTc dispersion (ΔQTc dispersion) (40.19±46.6 vs 4.39±14.35, p=0.04) from baseline was signifcantly higher in MAE group. In multiple regression analyses, ΔQTc dispersion predicted MAE (p=0.045, CI: 1.000–1.033).

Conclusion. Immediately after CRT implantation QTc dispersion and Tpe interval increases and increase in QTc dispersion predicts MAE in one year follow up.

Prehospital management of patients with acute coronary syndrome (ACS) is the essential element which influences the survival of patients and the outcome of the disease. Most lethal outcomes occur within the first hour after the onset of acute myocardial infarction (AMI), and the usual cause is some of heart rhythm and conduction disorder.

Aim. To assess the frequency of each form of ACS, and the incidence of the development of rhythm and conduction disorders during the first 12 hrs in relation to the localization of ACS and disease outcome.

Material and methods. We analyzed prospectively 107 patients transported under continual ECG monitoring to the Coronary Unit after ACS diagnosed prehospitally by the team of the Belgrade Emergency Medical Services. AMI localization was detected and the development of rhythm (supraventricular and ventricular), and conduction disorders were followed by prehospital ECG monitoring. Patients’ outcome was under follow-up until discharge from hospital.

Results. Acute ST-elevation myocardial infarction (STEMI), both anterior and diaphragmatic, is most frequent in men aged 50–59 years. There were no statistically significant differences in the occurrence of heart rhythm and conduction disorders both in the STEMI and non-STEMI (NSTEMI) groups. The most frequent rhythm disorders during the first 4 hrs after STEMI onset were sinus bradycardia, sinus tachycardia and ventricular tachycardia, while atrial fibrillation and single ventricular extrasystole were most frequent after 5–12 hrs. In STEMI, AV blocks occurred exclusively during the first 4 hrs, while bundle branch blocks occurred statistically more significantly during the first 4 hrs. Sinus bradycardia and atrioventricular blocks were statistically significantly associated with diaphragmatic STEMI. In this localization there were no bundle branch blocks. The most frequent rhythm disorder associated with anterior STEMI was sinus tachycardia that occurred exclusively during the first 4 hrs. The occurrence of ventricular tachycardia and ventricular fibrillation in any of STEMI locations was statistically more significant in the first 4 hrs after complaints onset. In the studied group of patients with ACS mortality rate was 12,1%, while in the group of STEMI patients it was 11%, with a significant frequency of infarction with anterior localization and bundle branch block in men.

Conclusion. Future studies should be directed toward identifying methods, as precise as possible, for early screening of heart rhythm and conduction disorders in ACS so as to enable a timely, preventive and therapeutic management.

Aim. This work aims to study the safety of tirofiban alone and in combination with various treatments in acute ischemic stroke (AIS).

Material and methods. 120 AIS patients were included in this study. There were 3 groups as below: Group A (tirofiban alone, n=68), Group B (tirofiban plus thrombolytic therapy, n=26), and Group C (tirofiban plus bridging therapy, n=26). Risk factors, stroke severity, initial imaging, treatment regimens, complications and longterm outcomes were analyzed.

Results. Eight patients (6,7%) in Group A, 6 patients (23,1%) in Group B and 2 patients (7,7%) in Group C had hemorrhage during or after treatment. Sixteen patients (6 in Group A, 8 in Group B and 2 in Group C) died during hospital admission. The mortality rate was 13,3% (8,8% for Group A, 30,7% for Group B and 7,7% for Group C, respectively) in the acute phase. A favorable outcome (mRS 0–2) at the first three months after stroke was only observed in 43,3% of patients (44,1% in Group A, 46,7% in Group B and 36,4% in Group C). The average Barthel index was 72,3 in Group A, 84,4 in Group B and 56,8 in Group C (total score: 71,0).

Conclusion. The stroke treatment with tirofiban is safe in AIS. A large randomized controlled trial in the future will be needed to decrease the minor bleeding complication of tirofiban therapy.

Aim. In this study, we investigated the impact of tirofiban on ventricular performance in patients who were diagnosed with acute coronary syndrome, found to have left main coronary artery stenosis during coronary angiography, and administered tirofiban prior to coronary artery bypass to prevent the recurrence of an acute coronary syndrome during the preoperative period.

Material and methods. The patients were divided into two groups. Group 1 included patients who were pre-diagnosed with acute coronary syndrome and administered tirofiban infusion in another hospital and subsequently sent to our center for advanced examination and treatment, where they exhibited left main coronary artery disease during coronary angiography and were submitted to surgery (n=28). Group 2 included patients who arrived at our emergency service with chest pain, were pre-diagnosed with acute coronary syndrome in the cardiology clinic, exhibited left main coronary artery disease during coronary angiography, and were submitted to urgent surgery without receiving tirofiban infusion (n=29). Standard and tissue Doppler echocardiography were applied to each patient in the preoperative and postoperative periods.

Results. After bypass surgery, the mean postoperative left ventricular myocardial performance index (0.84±0.30) was significantly lower than the mean preoperative left ventricular myocardial performance index (1.10±0.35) (p=0.001). The left lateral myocardial performance index was lower in group 1 (0.76±0.31) than in group 2 (0.92±0.27) (p=0.050*), but the ejection fraction was higher in group 1 (61.46±7.74) than in group 2 (52.87±11.64) (p=0.003*).

Conclusion. Preoperative administration of tirofiban improved postoperative left ventricular performance compared to pretreatment with aspirin alone in patients with left main coronary artery disease undergoing coronary artery bypass surgery. Therefore, we recommend the preoperative administration of tirofiban as an antithrombotic agent to patients who are undergoing coronary artery bypass for left main coronary artery disease.

Some studies have disclosed atrial fibrillation (AF) is associated with inflammation. Cystatin C is not only inflammatory markers but also an independent predictor of cardiovascular events.

Aim. We sought to investigate the relationship between serum levels of cystatin C and the occurrence and development of AF.

Material and methods. 134 paroxysmal and persistent AF (AF1 group) and 121 permanent AF (AF2 group) patients in AF group and 154 healthy people in control group were prospectively measured for cystatin C, other inflammatory markers, biochemical indicators, left atrial diameter (LAD), left ventricular diameter (LVD) and left ventricular ejection fraction (LVEF).

Results. (1) Compared with control and AF1 groups, AF2 group had higher values of cystatin C, high sensitivity C reactive protein (hsCRP), LAD and LVD whereas lower values of LVEF (P<0.05). (2) After adjust for age, gender and body mass index (BMI), correlation analysis showed that serum level of cystatin C was closely related to hsCRP, LAD, systolic blood pressure (SBP) and creatinine, the correlation coefficient were respectively 0.658, 0.502, 0.475 and 0.530 (P<0.01), but negatively associated with LVEF (P=0.011) in AF group. (3) Multivariate regression analysis showed the hsCRP, cystatin C, LAD and LVEF entered finally into the regression equation (cystatin C, OR: 3.41, 95%CI: 1.09–11.08, P=0.009).

Conclusion. The serum levels of cystatin C has significant correlation with AF, which indicates cystatin C may play an important role in the process of AF development.