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K Wrabec

Publications and source records attributed to K Wrabec.

At least 19 recordsLinked to original sources
PubMed2005

Trends in the incidence of the free wall cardiac rupture in acute myocardial infarction. observational study: experience of a single center.

PURPOSE: Free wall cardiac rupture (CR) is one of the most common cause of in-hospital death in acute myocardial infarction (AMI). The early diagnosis of CR and selection of the patients predisposed to CR become an important clinical tool. AIM: assessing the occurrence of CR in patients with AMI, to determine the factors which could help to identify the patients threatened with CR. MATERIAL AND METHODS: 2320 consecutive patients with AMI. CR was proved by autopsy or by echocardiography performed during cardio-pulmonary resuscitation (CPR). RESULTS: In-hospital mortality was 11% (254 patients). 50 patients (2%) died from CR. CR was the cause of 20% of total in-hospital death. Patients with CR were older than survivors (72 vs 60 years, p<0.0001). Women prevailed in CR group: (62% in CR group vs 27% in the survivors, p<0.01). 29% of patients were treated with thrombolytics (Th+). Out of 58 patients from Th (+) group who died, 17 (29.31%) died because of CR. CR occurred in 33 (16.8%) patients out of 196 died in Th (-) group. In the logistic regression analysis only age and sex remained as predictors of CR. 16 patients died from CR during first 24 h from admission (ECR). In 34 patients CR occurred >24 h (LCR). In ECR group were no prevalence of women, while in LCR women constituted 68%. In ECR group all but one patient had no previous history of MI (p=0.06). Frequency of thrombolythic therapy was equal. CONCLUSIONS: Advanced age patients, particularly women with first AMI are at risk of CR. Decision of thrombolytic treatment in this group of patients must be very cautious.

Acute Disease↗
PubMed2001

Prognostic factors in medically treated patients with chronic pulmonary embolism.

OBJECTIVE: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy. STUDY DESIGN: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months). RESULTS: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean +/- SD) level of PaO(2) (59.3 +/- 11 mm Hg) than the nonsurvivors (50.8 +/- 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30.3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 +/- 6 vs 44.2 +/- 6; p = 0.03), and better exercise tolerance (4.8 +/- 3 multiples of resting O(2) consumption [METs] vs 2.5 +/- 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04). CONCLUSION: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance.

Anticoagulants↗
PubMed1999

Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial.

We aimed to assess the clinical efficacy of glucose-insulin-potassium (GIK) in acute myocardial infarction. Experimental data provided evidence of the beneficial effects of GIK on ischemic myocardium. The clinical trials, mostly uncontrolled and conducted mainly before the thrombolytic era, were inconclusive due to the small number of patients and discrepancies in protocols. In order to evaluate the efficacy of this intervention, we have performed a prospective multicenter randomized study. The study consisted of 954 patients with acute myocardial infarction (MI) randomized within 24 hours from the onset of symptoms to low-dose GIK (n = 494), which consisted of 1000 mL 10% dextrose, 32-20 U insulin, and 80 mEq K-, or to the control group (n = 460), which was given 1000 mL 0.89% sodium chloride, by intravenous 24-hour infusion at a rate of 42 mL/h. Cardiac mortality and the occurrence of cardiac events at 35 days did not differ between GIK and control-allocated patients (32 (6.5%) vs. 21 (4.6%), respectively; OR 1.45, 95% CI 0.79-2.68, P = 0.20; and 214 (43.3%) vs. 192 (41.7%), OR 1.07, 95% CI 0.82-1.38, P = 0.62). Total mortality at 35 days was significantly higher in the GIK than in the control group (44 (8.9%) vs. 22 (4.8%), respectively, OR 1.95, 95% CI 1.12-3.47, P = 0.01). The excess of non-cardiac deaths in the GIK group may have occurred by chance. Low-dose GIK treatment does not improve the survival and clinical course in acute MI.

Aged↗
PubMed1999

[Echocardiographic assessment of pathologic geometry in the left left ventricle with aneurysm before and after endoventricular plasty].

UNLABELLED: Large LV aneurysm (LVA) leads to progressive distortion of ventricular geometry. Endoventricular plasty (EVP) maintains LV original shape and size and may restrain this process. AIMS: Echocardiographic estimation of LVA size. Assessment of the results of EVP regarding operative technique. Assessment if the initial parameters of LV function and LVA size could predict the choice of surgical technique. MATERIAL AND METHOD: 33 patients with LVA underwent EVP: 18 with patch (group A), 15 without patch (group B). Echocardiography was performed before and after surgical procedure. LVA-area, LVA-volume, its proportion to LV area and volume (LVA-area/LV-EDA, LVA-volume/LV-EDV) were determined apart from routine parameters of LV function. RESULTS: Mean LVA-area was 15 cm2, LVA-volume was 50 mL. Mean LVA-areal LV-EDA was 0.38 LVA-volume/LV-EDV was 0.35. LVA exceeding 0.4 of LV area/volume was considered as a large. After surgery LV-EDV diminished +/- 40 mL, LVLd decreased +/- 1.5 cm. EF improved from 44% to 54%. Patients in group A had larger LVA-volume (60 vs 39 ml, p = 0.02) as well as LV-EDV (160 vs 120 ml, p = 0.03), and lower EF (41% vs 51% p = 0.002). Only 2 patients with LVA-volume greater than 56 ml were operated on without patch. After surgery echocardiographic parameters did not differ between the groups: in group A operation was much more extensive. SUMMARY: 1.) Echocardiographic parameters concerning size (LVA-area, LVA-area/LV-EDA) and volume (LVA-volume, LVA-volume/LV-EDV) of LVA provides information about disturbances in LV geometry, are valuable in planning operative method. 2.) EVP with or without patch provides significant improvement of LV geometry and function in echocardiographic investigation.

Adult↗
PubMed1998

Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive heart failure.

In chronic congestive heart failure (CHF) an overactivity of muscle ergoreceptors and peripheral chemoreceptors may lead to an increased ventilatory response to exercise and contribute to the autonomic imbalance. The analysis of heart rate variability (HRV), which is a reliable method of studying autonomic regulations within the cardiovascular system, showed depressed HRV indexes in CHF, but predictors of abnormal HRV pattern in CHF remain controversial. Considering a common mechanism involved in generation of both abnormal ventilation and autonomic dysfunction in CHF, we hypothesized that impaired ventilation may be better than other variables of CHF severity in determining HRV parameters. Seventy-two patients with CHF (57+/-9 years, ejection fraction: 28+/-11%) underwent cardiopulmonary exercise testing; the relation between ventilation and carbon dioxide production (VE/VCO2) was used as an index of the ventilatory response to exercise. Time and frequency-domain measurements of HRV were derived from 24-hour electrocardiographic monitoring. Patients had reduced exercise tolerance with abnormal ventilatory response (peak oxygen consumption [VO2max]: 17.8+/-5.5 ml/kg/min, VE/VCO2: 36.0+/-9.8). Correlations were found between HRV measures and etiology, New York Heart Association (NYHA) functional class, and VO2max, but the strongest relation was observed for VE/VCO2 slope (r values from -0.33 to -0.65, p <0.01). In the multiple regression analysis only VE/VCO2 was found to correlate independently with all HRV measurements. To investigate the role of peripheral chemoreceptor overactivity as the mechanism of autonomic imbalance and the increased ventilatory response to exercise, we assessed peripheral chemosensitivity in 22 patients (mean value of peripheral chemosensitivity: 0.62+/-0.34 L/min/%SaO2, significantly higher than in normal controls, mean value: 0.29+/-0.20 L/min/%SaO2 in our laboratory). The activity of the peripheral chemoreflex inversely correlated with all parameters of HRV. Increased ventilatory response to exercise correlated with depressed HRV measures in patients with CHF better than other clinical variables. An important role of the increased peripheral chemosensitivity in this relation may be relevant, being also a potential link between functional severity and sympathovagal imbalance in CHF.

Administration, Inhalation↗
PubMed1998

[The impact of 2-year rehabilitation on exercise tolerance and transcutaneous oxygen saturation during exercise in patients with chronic obstructive pulmonary disease].

We compared results of symptom-limited exercise test (ET) and percutaneous oxygen saturation (SaO2) during ET in rehabilitated COPD patients (R) and in control COPD patients (C) before and after 2 years of study. Group of R consisted of 27 patients (FVC 2.15 l, FEV1 1.17 l, mean age 58, range 32-76 years) who underwent comprehensive, in-hospital and domestic R, group C consisted of 19 patients (FVC 1.95 l, FEV1 1.42 l, mean age 68, range 55-83 years). The studied groups did not differ in their FVC and FEV1, but R patients were younger (p = 0.05), had more sustained ET (p = 0.0002) and greater number of METs achieved during ET (p = 0.0008). After study we found increased number of METs during ET from 3.94 to 4.77, p = 0.003, improved 10 grade Borg score in 3' ET from 4.0 to 2.5, p = 0.05 and tendency to decrease maximal drop of SaO2 during ET from 6.8 to 3.1% (NS). Patients in C group failed to improve results of ET: from 2.7 to 2.5 METs (NS), and pulse oximetry: maximal drop in SaO2 during ET from 3.1 to 3.07%, NS) and also 10-grade Borg score in 3'ET (from 2.0 to 2.8, NS). In conclusion, although differences in age and in initial exercise tolerance between studied groups could influence the results of this study, it seems that long term rehabilitation can improve both exercise tolerance and oxygen saturation during exercise in COPD patients.

Adult↗
PubMed1998

[Comparison of 14-day rehabilitation and oxygen therapy on exercise tolerance and percutaneous oxygen saturation in patients with advanced COPD].

UNLABELLED: Whether rehabilitation may be as beneficial as oxygen therapy (T) in the management of chronic obstructive pulmonary disease (COPD) is still not known. The aim of the was to compare the effects of T or R on exercise tolerance (ET) and percutaneous oxygen saturation (SO2) at rest and at the peak exercise in 21 patients with COPD (FEV1, 1.29 L +/- 0.5) Eleven patients with COPD were treated with oxygen (17 hour per day) for 14 days and 10 patients were rehabilitated. Both groups did not differ in age 63.7 vs 69.3 years, in the baseline values of FEV1, PaCO2 and PaO2 and resting SO2%. Before the study patients R and T had similar resting SO2 values and ET (4.5 +/- 1 vs 3.4 +/- 2 METs, p = NS), but those in the R group revealed higher drop in SO2 at peak exercise test (10.9 vs 3.4%, p = 0.007). RESULTS: We found no significance impact of 14- day R and 14- day T on results of exercise test and exercise pulse oximetry in studied patients. However, rehabilitated patients, as opposite to patients on oxygen therapy had tendency to increase number of Mets and to diminish maximal drop in pulse oximetry during exercise. As a result, when we compared group R i T after study patients of R group differed from T patients with number of METs achieved (4.6 vs 3.0, p = 0.02), whereas maximal drop in SO2 at the peak exercise test in R and T patients equalized (7.9 +/- 7 vs 3.2 +/- 3%, p = NS). We conclude that the results of our short term study may suggest better effects of rehabilitation than oxygen therapy on exercise tolerance and oxygen saturation during exercise in COPD patients and justify further studies.

Aged↗
PubMed1998

[Diagnosis of chronic pulmonary embolism in patients with advanced chronic obstructive pulmonary disease].

The coexistence of chronic obstructive pulmonary disease (COPD) and chronic pulmonary embolism (PE) worsens prognosis and requires complex therapeutic procedures. However, the diagnosis COPD + PE is difficult because of similar clinical symptomatology. Pulmonary angiography was performed in 20 patients aged 60.9 (37-75) years with COPD and with clinical suspicion of chronic pulmonary embolism (PE). Of 13 patients with PE 8 had proximal PE and in 5 patients peripheral PE was found. Both groups of patients did not differ with regard to their age 60.2 +/- 7 vs 59 +/- 10 years (NS), FEV1 0.9 +/- 0.3 vs 1.1 +/- 0.4 l (NS) as well as platelet cells count, fibrinogen, hematocrit and hemoglobin. Patients with COPD + PE compared to patients with COPD had higher pH 7.38 +/- 0.05 vs 7.32 +/- 0.03 (p = 0.01), and tendency to lower PaCO2 44.3 +/- 12 vs 52.0 +/- 7 mmHg(NS), and higher mean pulmonary artery pressure 48 +/- 17 vs 36.3 +/- 9 mmHg(NS). Patients with COPD+ proximal PE compared to COPD patients had higher pH 7.4 +/- 0.05 vs 7.3 +/- 0.03 (p = 0.004) and lower paCO2 39.6 +/- 10 vs 52 +/- 7 mmHg (p = 0.03).

Adult↗
PubMed1997

Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

After acute myocardial infarction, depressed heart rate variability (HRV) has been proven to be a powerful independent predictor of a poor outcome. Although patients with chronic congestive heart failure (CHF) have also markedly impaired HRV, the prognostic value of HRV analysis in these patients remains unknown. The aim of this study was to investigate whether HRV parameters could predict survival in 102 consecutive patients with moderate to severe CHF (90 men, mean age 58 years, New York Heart Association [NYHA] class II to IV, CHF due to idiopathic dilated cardiomyopathy in 24 patients and ischemic heart disease in 78 patients, ejection fraction [EF], 26%; peak oxygen consumption, 16.9 ml/kg/min) after exclusion of patients in atrial fibrilation with diabetes or with chronic renal failure. In the prognostic analysis (Cox proportional-hazards model, Kaplan-Meier survival analysis), the following factors were investigated: age, CHF etiology, NYHA class, EF, peak oxygen consumption, presence of ventricular tachycardia on Holter monitoring, and HRV measures derived from 24-hour electrocardiography monitoring, calculated in the time (standard deviation of all normal RR intervals [SDNN], standard deviation of 5-minute RR intervals [SDANN], mean of all 5-minute standard deviations of RR intervals [SD], root-mean-square of difference of successive RR intervals [rMSSD], and percentage of adjacent RR intervals >50 ms different [pNN50]) and frequency domain (total power [TP], power within low-frequency band [LF], and power within high-frequency band [HF]). During follow-up of 584 +/- 405 days (365 days in all who survived), 19 patients (19%) died (mean time to death: 307 +/- 315 days, range 3 to 989). Cox's univariate analysis identified the following factors to be predictors of death: NYHA (p = 0.003), peak oxygen consumption (p = 0.01), EF (p = 0.02), ventricular tachycardia on Holter monitoring (p = 0.05), and among HRV measures: SDNN (p = 0.004), SDANN (p = 0.003), SD (p = 0.02), and LF (p = 0.003). In multivariate analysis, HRV parameters (SDNN, SDANN, LF) were found to predict survival independently of NYHA functional class, EF, peak oxygen consumption, and ventricular tachycardia on Holter monitoring. The Kaplan-Meier survival curves revealed SDNN < 100 ms to be a useful risk factor; 1-year survival in patients with SDNN < 100 ms was 78% when compared with 95% in those with SDNN > 100 ms (p = 0.008). The coexistence of SDNN < 100 ms and a peak oxygen consumption < 14 ml/kg/min allowed identification of a group of 18 patients with a particularly poor prognosis (1-year survival 63% vs 94% in the remaining patients, p <0.001). We conclude that depressed HRV on 24-hour ambulatory electrocardiography monitoring is an independent risk factor for a poor prognosis in patients with CHF. Whether analysis of HRV could be recommended in the risk stratification for better management of patients with CHF needs further investigation.

Aged↗
PubMed1997

[Value of classical and new criteria of electrocardiography in diagnosis of hypoxic cor pulmonale evaluated by hemodynamics tests].

Electrocardiogram is commonly used in the diagnosis of cor pulmonale in patients with chronic obstructive pulmonary disease (COPD). Pulmonary hemodynamics being the definite method for diagnosis the disease can be used to vary the ecg criteria for diagnosis cor pulmonale. After excluding patients with old myocardial infarction and with pulmonary wedge pressure > 12 mm Hg in 66 patients aged 65.2 with advanced COPD (FEV1 0.78 +/- 0.3 litre) pulmonary hemodynamics and ecg were performed at the same time. The signs of right ventricular hypertrophy were sought for using 3 sets of criteria: the World Health Organisation criteria, new compiled Lehtonen et al. Criteria and right ventricular precordial leads. WHO criteria had a specificity and sensitivity of 50% and 57.6%, the modified right precordial leads-53% and 64.5% and compiled Lehtonen's criteria -57% and 59% respectively. In 32 patients with mild pulmonary hypertension (20-29 mm Hg) sensitivity of WHO criteria was 46.8%, right precordial leads -51.6%, and Lethonen and co. Criteria -50%, in 10 patients with moderate pulmonary hypertension (30-39 mm Hg) 59%-62.5%-50%, in 9 patients with severe hypertension (> or = 40 mm Hg) 100%-100%-100% respectively. Our studies confirm the poor sensitivity and of ecg criteria for diagnosis of cor pulmonale (pulmonary hypertension) in COPD. However, in mild and moderate pulmonary hypertension, sensitivity of ecg diagnosis of cor pulmonale is improved if right modifieds precordial leads are used. New, compiled Lehtonen's criteria failed to improved diagnosis of diagnosis of cor pulmonale. All studied sets of criteria are highly sensitive in COPD patients with severe pulmonary hypertension.

Adult↗
PubMed1994

[Effect of acute exercise on cardiac arrhythmias in the course of chronic obstructive pulmonary disease].

It is suggested that ventricular arrhythmias may be the reason of sudden death in stable patients with COPD. Strenuous effort might provoke danger ventricular arrhythmias in those patients. The impact of maximal exercise test on cardiac ventricular arrhythmias was studied in 24 patients with advanced chronic obstructive pulmonary disease (COPD). The treadmill, self limited exercise test according to Bruce protocol and accompanied by pulse oximetry was performed during 24 hour Holter monitoring. We found ventricular extrasystoles in all patients, in an average 492 +/- 770, complex ventricular extrasystoles in 17 patients and nonsustained ventricular tachycardia in 8 patients. 81% of all ventricular extrasystoles, 80% complex ventricular extrasystoles and 70% nonsustained ventricular tachycardia occurred during the test and up to 2 hour after the test. Patients with complex ventricular arrhythmias were younger and mostly achieved more MET during exercise, but they did not differ in advancing of COPD as measured by spirometry, gas measurements and echocardiography. Although maximal exercise test enhances ventricular arrhythmias it produced no sustained, symptomatic ventricular arrhythmias in patients with advanced and stable COPD.

Aged↗
PubMed1993

[Atrial fibrillation with chronic obstructive pulmonary disease].

We compared 8 patients with COPD and fixed atrial fibrillation (group I) and 46 patients with COPD and sinus rhythm in ecg (group II). None of the patients had valvular heart disease, arterial hypertension or clinical signs of coronary artery disease. The studied groups did not differ while comparing their gas measurements, spirometry, pulmonary hypertension and right ventricular diameter (as measured in echo study). Patients with fixed atrial fibrillation had larger circuit and area of right atrium (p = 0.001), left atrial and left ventricular diameter (p = 0.001) as well as lower LV function (expressed by FS%). In conclusion, enlargement of both atria may be considered as a cause for fixed atrial fibrillation in patients with COPD. However symptomless coronary artery disease rather then COPD may be the reason for this arrhythmia.

Aged↗
PubMed1993

[Dissecting aortic aneurysm complicated by rupture of the right coronary artery and acute myocardial infarction--in a person treated with fibrinolysis].

A case report of 45-year-old woman with acute inferior wall and right ventricle myocardial infarction treated with i.v. Streptokinase is presented. Few days later acute aortic dissection involving right coronary artery was detected. After six days the patient was successfully operated. She is in good condition 10 months afterwards.

Aortic Dissection↗
PubMed1993

[Constrictive pericarditis in a patient following prosthetic aortic valve replacement caused by postpericardiotomy syndrome].

A case of a 53-year old man is presented who developed postpericardiotomy syndrome and subsequently constrictive pericarditis following prosthetic aortic valve replacement due to severe aortic stenosis. The diagnosis was based on clinical picture and confirmed invasively. Nearly total excision of thickened fibrous pericardium resulted in a slow but full disappearance of constriction signs.

Aortic Valve↗