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Dynamics of metabolic signs after coronary bypass operation in patients with coronary artery disease with or without hypertension
126A
POSTERS: Coronary Artery Disease
These results show that patients with HT and HT-AMI have a magnitude of sympathetic hyperactivity of at least 30% relative to controls, and that this is even greater in HT-AMI. The data provide a possible explanation for the increased mortality observed in patients with hypertension complicated by AMI relative to patients with AMI and no history of hypertension. Key Words: Myocardial Infarction, Sympathetic Nervous System, Autonomic
P-263 STRESS-ECHOCARDIOGRAPHY IN REHABILITATION PERIOD AFTER BY-PASS SURGERY IN POST-INFARCT PATIENTS WITH PREOPERATIVE HEART FAILURE Valentina Yu. Goloskokova, Dildora T. Tulaganova, Anis L. Alyavi. Functional department, Research Institute of Medical Rehabilitation and Physical Therapy, Tashkent, Uzbekistan, Uzbekistan. Objectives: The study was performed to estimate effect of exercise training in rehabilitation period after bypass surgery in post-infarction patients with preoperative heart failure. Methods: 32 patients after bypass surgery in post-infarction period were investigated with stress echocardiography. All patients before surgery had myocardial infarction and congestive heart failure. Stress tests were performed in post-operative period (after 2-4 months). Dipyridamol-atropine test (DIP) was infused intravenously at a dose of 0,56mg/kg body weigh over 4 min, followed by 4 min of no agent and after that, at the case of the test was still negative, 0,28 mg/kg over 2 min. If test was still negative in 3 minute after DIP infusion 1 mg (in four divided doses of 0,25 mg) atropine was added. Wall-Motion Score Index (WMSI) was calculated with the recommendations of American Society of Echocardiography from 16-segment model of left ventricle. All patients were enrolled in our investigation were examined before and after 3-weeks rehabilitation period was included exercise training and other physical methods of rehabilitation. Results: The DIP test was positive in 29 (90,62%) patients before observation. The resting WMSI was 1,56⫹/⫺0,24. Of the positive tests, 18 were positive at low dose (⬍ or ⫽ 8 min) and 11 at high dose (⬎8 min up to 12 min). The WMSI at peak dose increased up to 1,82⫹/⫺0,34 (p ⬍ 0.05 vs. resting WMSI). After rehabilitation period resting WMSI was non-significant decreased to 1,49⫹/⫺0,31, but time to peak was prolonged (p⬍0.05 vs. baseline). The peak WMSI was significant decreased (1,72⫹/⫺0,30, p⬍0,05). Moreover, resting left ventricular ejection fraction increased from 50,67⫹/⫺3,98% to 54,45⫹/⫺3,75% (p⬍0,05). Conclusions: Exercise training may be recommended in rehabilitation period after bypass surgery in post-infarct patients with preoperative heart failure. Key Words: Stress Echocardiography, By-Pass Surgery, Heart Failure
P-264 DYNAMICS OF METABOLIC SIGNS AFTER CORONARY BYPASS OPERATION IN PATIENTS WITH CORONARY ARTERY DISEASE WITH OR WITHOUT HYPERTENSION Andrey G. Obrezan, Denis V. Kovlen. General Therapy1 1, Medical Military Academy, Saint-Petersburg, Russian Federation. The purpose of our research was to estimate the dynamics of metabolic signs in patients with coronary artery disease (CAD) with or without hypertension (H) after coronary bypass operation (CBO). In the study were included 35 patients (20 with only CAD and 15 with CAD and H) between 49 and 55 years old, which were undergone CBO with positive outcome. All patients had body mass index between 25 and 30 (28,3 in average). The blood tests were taken before, 2 months and 1
AJH–April 2002–VOL. 15, NO. 4, PART 2
year after operation. The most significant differences were in cholesterol, high density lipoproteins (HDL), cortisol and testosteron levels, and insulin resistance index (IRI). There were not any substantial differences in the metabolic signs before and after CBO in patients with CAD and H. An average levels are in the table. The presented data allow to conclude, that such metabolic signs as cholesterol, HDL, cortisol and testosteron levels, and IRI were excessive in patients with CAD and H even more than in patients with only CAD and did not differ 2 months and 1 year after operation. In patients with CAD we can see the decreased levels of cholesterol, cortisol and IRI, and increased level of HDL 2 months after CBO, which returned to the same ones as before operation during a period of just 1 year.
Only CAD
Cholesterol HDL Cortisol IRI Testosteron
Before CBO
2 months after
1 year after
CAD ⴙ H
6,9 0,9 470 1,90 2,0
5,0 1,3 410 0,47 12,0
6,8 0,9 453 1,72 22,0
7,9 0,7 491 2,14 19,9
Key Words: Coronary Artery Disease, Metabolism, Hypertension
P-265 AORTIC PULSE PRESSURE AND EXTENT OF CORONARY ARTERY DISEASE IN PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CANDIDATES Francois Philippe, Elie Chemaly, Jacques Blacher, Jean-Jacques Mourad, Alain Dibie, Fabrice Larrazet, Francois Laborde, Michel Safar. Departement de Cardiologie, Institut Mutualiste Montsouris, Paris, France, Metropolitan; Departement de Me´ decine Interne, Hopital Broussais, AP-HP, Paris, France, Metropolitan. Pulse pressure and aortic stiffness are both predictors of coronary artery disease. Whether these parameters are directly related to coronary structural alterations has never been studied. From September 1999 to September 2000, 99 eligible patients were collected with the following data: invasive intra-aortic systolic and diastolic blood pressures, extent of coronary artery disease, cardiovascular risk factors and the incidence of angiographically documented restenosis after coronary angioplasty. In the study population, independent determinants of aortic pulse pressure were age, gender, aortic mean blood pressure, heart rate and extent of coronary artery disease(r2⫽0.57, p⬍0.0001). In univariate analysis, invasive aortic, but not non invasive brachial, mean pressure (p⫽0.017) and pulse pressure (p⫽0.027) were significantly associated to the extent of coronary artery disease. In a multiple regression analysis, only male gender (p⫽0.013) and the level of aortic pulse pressure (p⫽0.023) were independently associated with the extent of coronary heart disease. Restenosis was angiographically documented in 11 patients (11%). There was a borderline significant association of restenosis to aortic mean blood pressure (p⫽0.05) and to a past story of multiple previous angioplasty (p⫽0.03). In this study, aortic pulse pressure was a significant risk factor for the extent of coronary artery disease. There was only a borderline significant association of restenosis to the steady, but not pulsatile, component of aortic blood pressure in the stent era. Key Words: Pulse Pressure, Coronary Angioplasty, Aortic Pressure
POSTERS: Coronary Artery Disease
These results show that patients with HT and HT-AMI have a magnitude of sympathetic hyperactivity of at least 30% relative to controls, and that this is even greater in HT-AMI. The data provide a possible explanation for the increased mortality observed in patients with hypertension complicated by AMI relative to patients with AMI and no history of hypertension. Key Words: Myocardial Infarction, Sympathetic Nervous System, Autonomic
P-263 STRESS-ECHOCARDIOGRAPHY IN REHABILITATION PERIOD AFTER BY-PASS SURGERY IN POST-INFARCT PATIENTS WITH PREOPERATIVE HEART FAILURE Valentina Yu. Goloskokova, Dildora T. Tulaganova, Anis L. Alyavi. Functional department, Research Institute of Medical Rehabilitation and Physical Therapy, Tashkent, Uzbekistan, Uzbekistan. Objectives: The study was performed to estimate effect of exercise training in rehabilitation period after bypass surgery in post-infarction patients with preoperative heart failure. Methods: 32 patients after bypass surgery in post-infarction period were investigated with stress echocardiography. All patients before surgery had myocardial infarction and congestive heart failure. Stress tests were performed in post-operative period (after 2-4 months). Dipyridamol-atropine test (DIP) was infused intravenously at a dose of 0,56mg/kg body weigh over 4 min, followed by 4 min of no agent and after that, at the case of the test was still negative, 0,28 mg/kg over 2 min. If test was still negative in 3 minute after DIP infusion 1 mg (in four divided doses of 0,25 mg) atropine was added. Wall-Motion Score Index (WMSI) was calculated with the recommendations of American Society of Echocardiography from 16-segment model of left ventricle. All patients were enrolled in our investigation were examined before and after 3-weeks rehabilitation period was included exercise training and other physical methods of rehabilitation. Results: The DIP test was positive in 29 (90,62%) patients before observation. The resting WMSI was 1,56⫹/⫺0,24. Of the positive tests, 18 were positive at low dose (⬍ or ⫽ 8 min) and 11 at high dose (⬎8 min up to 12 min). The WMSI at peak dose increased up to 1,82⫹/⫺0,34 (p ⬍ 0.05 vs. resting WMSI). After rehabilitation period resting WMSI was non-significant decreased to 1,49⫹/⫺0,31, but time to peak was prolonged (p⬍0.05 vs. baseline). The peak WMSI was significant decreased (1,72⫹/⫺0,30, p⬍0,05). Moreover, resting left ventricular ejection fraction increased from 50,67⫹/⫺3,98% to 54,45⫹/⫺3,75% (p⬍0,05). Conclusions: Exercise training may be recommended in rehabilitation period after bypass surgery in post-infarct patients with preoperative heart failure. Key Words: Stress Echocardiography, By-Pass Surgery, Heart Failure
P-264 DYNAMICS OF METABOLIC SIGNS AFTER CORONARY BYPASS OPERATION IN PATIENTS WITH CORONARY ARTERY DISEASE WITH OR WITHOUT HYPERTENSION Andrey G. Obrezan, Denis V. Kovlen. General Therapy1 1, Medical Military Academy, Saint-Petersburg, Russian Federation. The purpose of our research was to estimate the dynamics of metabolic signs in patients with coronary artery disease (CAD) with or without hypertension (H) after coronary bypass operation (CBO). In the study were included 35 patients (20 with only CAD and 15 with CAD and H) between 49 and 55 years old, which were undergone CBO with positive outcome. All patients had body mass index between 25 and 30 (28,3 in average). The blood tests were taken before, 2 months and 1
AJH–April 2002–VOL. 15, NO. 4, PART 2
year after operation. The most significant differences were in cholesterol, high density lipoproteins (HDL), cortisol and testosteron levels, and insulin resistance index (IRI). There were not any substantial differences in the metabolic signs before and after CBO in patients with CAD and H. An average levels are in the table. The presented data allow to conclude, that such metabolic signs as cholesterol, HDL, cortisol and testosteron levels, and IRI were excessive in patients with CAD and H even more than in patients with only CAD and did not differ 2 months and 1 year after operation. In patients with CAD we can see the decreased levels of cholesterol, cortisol and IRI, and increased level of HDL 2 months after CBO, which returned to the same ones as before operation during a period of just 1 year.
Only CAD
Cholesterol HDL Cortisol IRI Testosteron
Before CBO
2 months after
1 year after
CAD ⴙ H
6,9 0,9 470 1,90 2,0
5,0 1,3 410 0,47 12,0
6,8 0,9 453 1,72 22,0
7,9 0,7 491 2,14 19,9
Key Words: Coronary Artery Disease, Metabolism, Hypertension
P-265 AORTIC PULSE PRESSURE AND EXTENT OF CORONARY ARTERY DISEASE IN PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CANDIDATES Francois Philippe, Elie Chemaly, Jacques Blacher, Jean-Jacques Mourad, Alain Dibie, Fabrice Larrazet, Francois Laborde, Michel Safar. Departement de Cardiologie, Institut Mutualiste Montsouris, Paris, France, Metropolitan; Departement de Me´ decine Interne, Hopital Broussais, AP-HP, Paris, France, Metropolitan. Pulse pressure and aortic stiffness are both predictors of coronary artery disease. Whether these parameters are directly related to coronary structural alterations has never been studied. From September 1999 to September 2000, 99 eligible patients were collected with the following data: invasive intra-aortic systolic and diastolic blood pressures, extent of coronary artery disease, cardiovascular risk factors and the incidence of angiographically documented restenosis after coronary angioplasty. In the study population, independent determinants of aortic pulse pressure were age, gender, aortic mean blood pressure, heart rate and extent of coronary artery disease(r2⫽0.57, p⬍0.0001). In univariate analysis, invasive aortic, but not non invasive brachial, mean pressure (p⫽0.017) and pulse pressure (p⫽0.027) were significantly associated to the extent of coronary artery disease. In a multiple regression analysis, only male gender (p⫽0.013) and the level of aortic pulse pressure (p⫽0.023) were independently associated with the extent of coronary heart disease. Restenosis was angiographically documented in 11 patients (11%). There was a borderline significant association of restenosis to aortic mean blood pressure (p⫽0.05) and to a past story of multiple previous angioplasty (p⫽0.03). In this study, aortic pulse pressure was a significant risk factor for the extent of coronary artery disease. There was only a borderline significant association of restenosis to the steady, but not pulsatile, component of aortic blood pressure in the stent era. Key Words: Pulse Pressure, Coronary Angioplasty, Aortic Pressure