Experience of calculating interstitial collagen volumetric fraction in patients with hypertonic disease

The aim of the research is to optimize the assessment of collagen volumetric fraction in patients with stage 1 and 2 hypertensions. Material and methods. In total 39 patients with arterial hypertension took part in the study. Group 1 included patients (n = 13) with stage 1 hypertension, the second group included patients with stage 2 hypertension (n = 26). To verify structural changes in the left ventricle, all subjects underwent comprehensive examination, including history taking, anthropometric data taking, ECG study with the calculation of general QRS (mm) as a total indicator of R wave amplitude in 12 electrocardiographic leads, and echocardiography according to standard technique. Statistical analysis, based on the data obtained, was carried out using SPSS soft ware package. Furthermore, there was comparison of collagen volumetric fraction calculation (СVFC) according to the method of J. Shirani et al. (1992), and by our own formula based on nonlinear regression equation. Results. When calculating СVFC in accordance with the formula of J. Shirani et al. (1992), СVFC values (%) in the 1st group of subjects were 8.48 [5.5; 9.7]; in the 2nd group they were 11.16 [0.5; 1.7], (U = 51.0, p = 0.45). When studying groups СVFC in accordance with the alternative formula, more statistically signifi cant diff erences were observed: СVFC values in the 1st group were 23.5 [21.4; 30.4], in the 2nd group - 29.5 [25.5; 35.7] (U = 105.0, p = 0.049). Conclusion. The developed method for calculating collagen volumetric fraction is more pathogenetically suffi cient. Th is makes it possible to determine this indicator more accurately for identifying a group of patients suffering from stage 1 and 2 hypertension, with a high risk of heart failure development for its wide use in clinical practice to monitor them more frequent and to correct their therapy.

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Acute right ventricular infarction presenting with ST-segment elevation in the anterior precordial electrocardiographic leads is an unusual event. Anterior ST-segment elevation typically suggests occlusion of the left anterior descending coronary artery. It should be recognized, however, that occlusion of a right coronary artery branch can cause isolated ST-segment elevation in leads V1 and V2 on a standard 12-lead electrocardiogram. We describe the cases of 2 patients who presented with acute chest syndrome with isolated ST-segment elevation in leads V1 and V2. Emergency coronary angiograms revealed that acute thrombotic occlusion of the right ventricular marginal branch of the dominant right coronary artery caused the clinical manifestations in the first patient, whereas occlusion of the proximal nondominant right coronary artery was the culprit lesion in the second patient. Both lesions caused right ventricular myocardial infarction. The patients underwent successful primary percutaneous coronary intervention. These cases illustrate the importance of carefully reviewing angiographic findings to accurately diagnose an acute isolated right ventricular myocardial infarction, which may mimic the electrocardiographic features of an anterior-wall myocardial infarction.

Continuous ECG Monitoring in Patients With Acute Coronary Syndrome or Heart Failure: EASI Versus Gold Standard

The purpose of the study was to compare the EASI system with the standard 12-lead surface electrocardiogram (ECG) for the accuracy in detecting the main electrocardiographic parameters (J point, PR, QT, and QRS) commonly monitored in patients with acute coronary syndromes or heart failure. In this observational comparative study, 253 patients who were consecutively admitted to the coronary care unit with acute coronary syndrome or heart failure were evaluated. In all patients, two complete 12-lead ECGs were acquired simultaneously. A total of 6,072 electrocardiographic leads were compared (3,036 standard and 3,036 EASI). No significant differences were found between the investigate parameters of the two measurement methods, either in patients with acute coronary syndrome or in those with heart failure. This study confirmed the accuracy of the EASI system in monitoring the main ECG parameters in patients admitted to the coronary care unit with acute coronary syndrome or heart failure.

A Case of Spontaneous Multivessel Coronary Artery Spasm That Underwent Stent Implantation Accompanying ST Segment Elevation on Inferior Electrocardiographic Leads

Coronary artery spasm is usually defined as a focal constriction of a coronary artery segment, which is reversible, and causes myocardial ischaemia by restricting coronary blood flow. A coronary spasm may rarely compromise all three epicardial arteries simultaneously. We present a case of severe coronary spasm afflicting all coronary arteries accompanying an ST segment elevation in leads D2-D3 and aVF.