Slovakia
online
Volume 97 / No. 6 / 1996
THE PROBLEM OF CARDIOMYOPATHIES REGARDING THE CLINICAL AND EXPERIMENTAL CARDIOLOGY
GVOZDJAK J., GVOZDJAKOVA A., KUCHARSKA J., BADA V.
The study represents a summary of the latest experience, definitions,
classification and diagnostics in cardiomyopathologic diseases. The main
attention is drawn to the pathogenesis of cardiomyopathies, especially
regarding the metabolic disturbances of the cardiac muscle on the mitochondrial
level: the disturbances of oxidative and related energetic processes which
the authors have registered in coincidence with the cardiomyopathological
alcohol and smoking experimental model. The conclusion includes a notice
about the prospective possibility for human cardiology to study these metabolic
disturbances in endomyocardial biopsies in order to assess the diagnosis
in early thus still reversible stages. (Ref. 7.)
Key words: cardiomyopathies, mitochondrial cardiomyopathies, pathogenesis,
metabolic disturbances.
Bratisl Lek Listy 1996; 97: 323–324
CARDIOPATHIES OF UNKNOWN ORIGIN COOPERATIVE INTERDISCIPLINARY STUDY
FABIAN J., BACHAROVA L., DANIS D., GVOZDJAKOVA A., KOZLOVSKY M., KUCHARSKA J., MARGITFALVI P., MIZERA S., PECHAN I., SCHRAMEKOVA E., SCHREINEROVA Z., SLUGEN I.
The authors described aim. objectives, design and criteria of the study
which is oriented to the clinical and research problems of heart diseases
of uncertain origin. The paper presents the preliminary experience with
invasive cardiological techniques in this field. At the same time the authors
discuss the potential impact of the basic research on the prevention and
effective treatment of cardiopathy which is until now of unknown origin.
(Tab. 3, Fig. 1, Ref. 15.)
Key words: cardiopathy of unkonwn origin, interventional cardiology.
Bratisl Lek Listy 1996; 97: 325–329
CLINICAL VIEW OF CARDIOPATHY OF UNKNOWN ORIGIN
SCHRAMEKOVA E., FABIAN J., SCHREINEROVA Z., MIZERA S., MARGITFALVI P., KOZLOVSKY M.
Frequently even physical and noninvasive examinations with laboratory
analysis do not determine the final aetiology of cardiac symptoms, and
it is necessary to complete them with an invasive examination with the
aim of ascertaining the primary cause. Our article gives information about
the results of clinical, laboratory and noninvasive examinations in the
group of patients suscepted of cardiopathy of unknown origin. (Tab.
2, Fig. 7, Ref. 12.)
Key words: cardiopathy of unknown origin, cardiac symptoms, invasive
examination, noninvasive examination, cardiology.
Bratisl Lek Listy 1996; 97: 330–333
ANGIOCARDIOGRAPHY OF CARDIOPATHIES OF UNKNOWN ORIGIN
MIZERA S., FABIAN J., FRIDRICH V., DANIS D., SCHREINEROVA Z., SCHRAMEKOVA E.
Authors described their experiences with angiocardiography, (selective
coronarography and left ventriculography), in 41 patients aged from 32
to 59 years with the preliminary diagnosis of cardiopathy of unknown origin.
The patients with diagnosis of cardiopathy of unknown origin were those,
who cannot be assigned to any of the known and acknowledge diagnostic cathegories,
not even by using complex clinical, laboratory and noninvasive cardiological
diagnostic procedures. Angiocardiography enabled to produce new and unexpected
data of diagnostic value three patients with heart disease (all of the
three mentioned patients had significant changes of the coronary supply,
i.e. the reduction in lumen diameter of the coronary vessel being of more
than 50 % with local or total wall motion abnormalities). The other thirt-eight
patients had normal findings of the coronary supply. One patient had a
normal coronarographic finding, normal left ventricular wall motion and
also the subsequent histological examination from the endomyocardial bioptic
sample of the heart tissue, did not confirm pathological abnormalities.
Selective coronarography and left ventriculography is a useful and safe
clinical diagnostic procedure in exactly defined groups of patients. (Tab.
4, Fig. 3, Ref. 19.)
Key words: cardiopathy of unknown origin, selective coronarography,
left ventriculography.
Bratisl Lek Listy 1996; 97: 334–339
ECHOCARDIOGRAPHY OF CARDIOPATHIES
KOZLOVSKY M., MARGITFALVI P., MIZERA S., SCHREINEROVA Z., SCHRAMEKOVA E., PECHAN I., FABIAN J.
The authors deal with the relation of echocardiography and diseases
of the cardiac muscle, draftly classified as cardiopathies. The author’s
starting point is issued from the presumption that heart diseases which
lack the characteristic diagnostic signs in echocardiographic picture affect
the heart’s systolic and diastolic functions. Echocardiography enables
to quantify the extent of affliction of both functions. On the basis of
analysis of a set of 22 prospectively examined patients the authors judge
as to wether the results of individual volume measurements by means of
echocardiographic imaging (one dimensional, two dimensional, Doppler) are
correct. In the frame of systolic and diastolic functions examination they
highlight the Doppler evaluation due to its technical simplicity and good
correlations with literal documents dealing with invasive examinations.
(Fig. 7, Ref. 7.)
Key words: echocardiography, cardiopathy, systolic and diastolic
functions.
Bratisl Lek Listy 1996; 97: 340–343
PARAMETERS OF OXIDATIVE STRESS IN PATIENTS WITH CARDIOPATHIES
PECHAN I., MINAROVA H., BABUSIKOVA F., RENDEKOVA V., MIZERA S., SCHRAMEKOVA E., URSINYIOVA M., FABIAN J.
Background: Routine biochemical parameters in the blood of patients
with chronic cardiopathies are nonspecific and of no reliable diagnostic
value.
Objectives: Since marked changes of some biochemical blood parameters
concerning the oxidative metabolism of the organism were observed in patients
with acute myocardial diseases, the aim of this study was to estimate some
antioxidant enzyme activities and metabolites in the blood of patients
with cardiopathies — diseases with chronic heart failure of unknown origin.
Methods: In 21 hospitalized patients with cardiopathy the venous
blood samples were analyzed for plasma levels of thiobarbituric acid reactive
substances (TBARS) as representatives of lipid peroxidation, levels of
selenium and zinc as well as the activities of superoxide dismutase (SOD)
and glutathione peroxidase (GPX) and reduced glutathione (GSH) level in
erythrocytes.
Results: Comparing the group of 25 clinically healthy individuals
some marked changes in enzyme activities and metabolite levels were found
in patients with cardiopathy: a significant increase of plasma TBARS and
— on the other hand — markedly decreased activities of SOD and GPX and
of GSH level in erythrocytes. Also a decreased plasma selenium level was
observed in patients.
Conclusions: A marked decrease of antioxidant enzyme activities
and GSH levels suggest a possible drop in total antioxidant status of patients
with cardiopathy. Rised TBARS plasma levels might be regarded as a decreased
ability of organism to abolish the produced free reactive oxygen forms
leading thus to rise in lipoprotein rare. (Tab. 1, Fig. 1, Ref. 17.)
Key words: cardiopathy of unknown origin, antioxidant enzymes,
glutathione, lipid peroxidation, trace elements.
Bratisl Lek Listy 1996; 97: 344–347
METABOLIC STUDIES OF MITOCHONDRIA IN BIOPTIC SAMPLES OF MYOCARDIUM IN PATIENTS WITH CARDIOPATHIES OF UNKNOWN ORIGIN
GVOZDJAKOVA A., KUCHARSKA J., MIZERA S., SNIRCOVA M., SCHREINEROVA Z., SCHRAMEKOVA E., PECHAN I., FABIAN J.
Background: Mitochondrial cardiomyopathies are being studied
as metabolic diseases of the cardiac muscle which represents a new approach
in metabolic studies. The development of mitochondrial diseases is concomited
by an impairment in complexes of mitochondrial respiratory chain, which
so far could have been possibly studied exclusively on experimental animals.
The method of skinned? fibers enables to measure the pathobiochemical processes
in mitochondria in a small amount of bioptic myocardial tissue of patients.
Aim: The study is aimed at: applying the method of skinned fibers
in biopsy of myocardium in patients, trying to localize the impaired loci
of the mitochondrial respiratory chains, prospective early and fast assessment
of the diagnosis of mitochondrial cardiomyopathy in patients.
Conclusions: The study brings the first information on the possibility
of performing more value measurements of mitochondrial respiratory chains
per one bioptic sample from the myocardium in patients. The preliminary
results indicate to the prospective possibility of early and fast assessment
of the diagnosis of mitochondrial cardio(myo)pathies. The presented results
require complementary studies involving the development of „mitochondrial
medicine". (Fig. 3, Ref. 13.)
Key words: mitochondrial respiratory chain, endomyocardial biopsy,
patients with cardiopathies of unknown origin.
Bratisl Lek Listy 1996; 97: 348–350
THE ASSESSMENT OF COENZYME Q[_10] AND ALPHA-TOCOPHEROL IN PATIENTS WITH CARDIOPATHIES OF UNKNOWN ORIGIN: PROSPECTIVE DIAGNOSTIC POSSIBILITIES
KUCHARSKA J., GVOZDJAKOVA A., SNIRCOVA M., MIZERA S., SCHRAMEKOVA E., SCHREINEROVA Z., PECHAN I., FABIAN J.
The coenzyme Q[_10] (ubiquinone) plays an important role in bioenergetic
conditions in myocardiac cells and together with alpha-tocopherol they
act as endogenous antioxidants. Decreased levels in coenzyme Q[_10] were
confirmed in some types of cardiomyopathies and in failing myocardium.
Insufficiency of E vitamin is a risk factor in cardiovascular diseases.
The study investigates the levels of coenzyme Q[_10] and alpha-tocopherol
in the blood and in bioptic samples of the myocardium in patients with
cardiopthies of unkown origin and it is aimed at their application as an
auxilliary diagnostic method. The authors have introduced a method of coenzyme
Q[_10] and alpha-tocopherol assessment from the bioptic samples of the
myocardium, from the blood and plasma of these patients by means of high-performance
liquid chromatography (HPLC).
The authors detected decreased levels of coenzyme Q[_10] in the myocardium
and blood of patients with cardiopathies. The dependence on the functional
state of the myocardium according to NYHA was not confirmed due to the
small number of patients. The plasmatic alpha-tocopherol levels decreased
in dependence on the severeness of the disease. A more significant dependence
was detected between the levels of alpha-tocopherol in the myocardium and
its functional state. The average myocardial level of alpha-tocopherol
in patients of the NYHA II group was almost ten-fold higher than in the
NYHA II group.
The gained results appoint to the meaning of investigation of the coenzyme
Q[_10] and alpha-tocopherol in patients with cardiopathies of unknown origin
and give a hint of prospective possibilities for application in the diagnosis
assessment. (Tab. 2, Ref. 22.)
Key words: cardiopathies of unknown origin, endomycardial biopsies,
coenzyme Q[_10], alpha-tocopherol.
Bratisl Lek Listy 1996; 97: 351–354
THE EFFECT OF ALPHA-TOCOPHEROL ANALOGUE MDL 73,404 ON BIOENERGETIC CONDITIONS IN MYOCARDIUM
SNIRCOVA M., KUCHARSKA J., HERICHOVA I., BADA V., GVOZDJAKOVA A.
The authors investigated the effect of the synthetic analogue of MDL
73, 404 alpha-tocopherol on bioenergetic processes of the cardiac muscle
in a control group of rats. After a 10-day application of the presented
preparation they analyzed the following parameters of energetic metabolism:
ATP, ADP, AMP and inorganic phosphorus. Beside these, the authors investigate
the levels of main indicators of the purine metabolism (xanthine, hypoxanthine,
inosine and uric acid) in the myocardium. Under the influence of the given
analogue of alpha-tocopherol a significant increase in ATP, ADP and hypoxanthine
took place in the myocardium. Also the total concentration of adenine nucleotide
and relative ATP/ADP ratio increased in the cardiac muscle.
On the basis of the gained results the authors came to a conclusion
that the synthetic analogue of alpha-tocopherol MDL 73,404 has a favourable
effect on the bioenergetic conditions in the myocardium. MDL 73,404 has
a favourable cardioprotective effect on the cardiac muscle assumedly by
means of stabilization of mitochondrial membranes on the mycardium with
a subsequent impact on cellular ATP concentration. (Fig. 3, Ref. 16.)
Key words: myocardium, alpha-tocopherol, adenine nucleotides.
Bratisl Lek Listy 1996; 97: 355–359
EPIDEMIOLOGY OF CARDIOPATHIES OF UNKNOWN ORIGIN
KARVAJ M., DURIS T., KLOBUCNIKOVA Z., URGEOVA L., FABIAN J.
Background: Cardiopathy of unknown origin is a precise term classifying
a group of diseases which define an assessment of diagnosis by means of
available non-invasive examinations. The pathological finding is obvious,
however it does not fulfill unambiquously the diagnostic criteria for a
particular noseologic entity. We assume that subclinical forms of dilatation
cardiomyopathy may be involved.
Aim: Detection of incidence of cardiomyopathies within the population
in the district of Nove Zamky.
Methods: The retrospective analysis of patients examined at
the Clinic of Non-invasive Cardiology at Nove Zamky in 1994.
Results: The total of examined patients reached the figure of
178, out of whom 5 were treated due to the suspected cardiopathy of unknown
origin.
Conclusion: 1. It is not possible to assess the definitive diagnosis
on the level of second contact. 2. The patients with the diagnosis of cardiomyopathy
of uncertain origin require a long-term check-up. 3. It would be beneficial
to compare the data with another Slovak territorial district, or region.
Practical application: It is necessary to bring the patients
under control in the early subclinical stage of dilatation cardiomyopathy,
to devote a more intensive care and to influence selectively the actual
harmful factors and thus inhibit the development of the disease. (Tab.
3, Ref. 10.)
Key words: cardiomyopathies of unknown origin, dilatation cardiomyopathy.
Bratisl Lek Listy 1996; 97: 360–362
MORPHOLOGY OF CARDIOMYOPATHIES
JANIK P.
On the basis of definitions and classification of cardiopathies worked
out by a group of WHO experts (1983) the author demonstrates the macroscopic
and microscopic findings in dilatation, hypertrophic and restrictive cardiomyopathies
(Fig. 3, Ref. 5).
Key words: Cardiomyopathy, macroscopic changes, micro-scopic changes.
Bratisl Lek Listy 1996; 97: 363–364
EFFECT OF GLOBAL BRAIN ISCHEMIA ON ERYTHROCYTE DEFORMABILITY AND CEREBRALE MICROCIRCULATION IN DOG
POMFY M., NICAK A.
The state of cerebral ischemia and the following recirculation affect
also the blood rheology. The erythrocyte microrheology was studied less
than the blood plasma changes. The presented paper is focused on the erythrocyte
microrheology changes after global brain ischemia. Both mild and serious
global ischemia were induced by the exclusion of cerebral blood circulation
for seven min. Thereafter followed the period of recirculation. The changes
of erythrocyte microrheology were studied using the method of colloid-osmotic
hemolysis.
After 180 minutes of recirculation, a significant increase of colloid-osmotic
hemolysis was observed. After this until the 240th a significant decrease
of colloid-osmotic hemolysis followed. In the group in which mild cerebral
ischemia was induced the above mentioned changes were only slightly presented.
Important is the fact that the changes in erythrocyte microrheology after
serious brain ischemia are in correlation with the changes in cerebral
microcirculation. After serious brain ischemia the trombotisation as well
as the blood stasis occurred (no-reflow phenomenon). (Fig. 3, Ref. 23.)
Key words: global cerebral ischemia, recirculation, erythrocyte
microrheology, dog.
Bratisl Lek Listy 1996; 97: 365–368