In this study, we randomly compared single oral doses of flecainide, amiodarone and propafenone versus placebo for the conversion of recent atrial fibrillation (AF) (within 48 hours).This is a randomized prospective, placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were randomly assigned to single oral doses of flecainide (3 mg/kg of weight, n=40), amiodarone (30 mg/kg weight, n=40), propafenone (8.5 mg/kg of weight, n=40) or placebo (n=40). The primary end-point was conversion rate at 24 hours after the drug intake. The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions.The primary end-point was achieved in 87.5% of patients with flecainide, 85% of patients with amiodarone, 85% of patients with propafenone and 17.5% of patients with placebo (p<0.001 compared with placebo for all 3 drugs). Conversion rate within 3 hours after drug intake was greater with propafenone (57.5%) or flecainide (45%) compared with amiodarone (0%) or placebo (10%). Between 6 and 24 hours, significantly more patients were converted to sinus rhythm with amiodarone than with flecainide or propafenone. The use of antiarrhythmic drugs was a significant predictor of conversion to sinus rhythm compared to placebo (adjusted OR=19.53, 95% CI 3.14-121.55, p<0.001). No serious side effect occurred.In patients with recent-onset AF, oral flecainide, amiodarone or propafenone are superior to placebo in restoring sinus rhythm within the 24-hour period following the drug intake.
Objectives: Hypertension is one of the strongest modifiable risk factor for cardiovascular and kidney disease and the leading risk factor for mortality.Rapid controlled reduction of blood pressure (BP) may be necessary to prevent or minimize end-organ damage, despite the increased costs.Aim: To compare the cost-effectiveness of the treatment for the hypertensive crisis.Patients and Methods: 722 patients (pts) with high BP systolic blood pressure (SBP) >180 and diastolic blood pressure (DBP >90 mmHg, without signs of end-organ damage, contraindications for four drugs, who were admitted in the emergency department were enrolled in a prospective, single-blind study.The pts were selected to be treated with 20 mg nifedipine sublingual (s/l) (n=314pts), 20 mg furosemid iv (n=102 pts), nitroglycerin iv 5mg/5ml starting with 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes (n=63 pts), 20 mg enalapril s/l (n=243 pts).Electrocardiographic (ECG) recordings and biochemical balance were obtained during and Echocardiographic after the treatment.Checkup of BP was made after 5 ', 10', 15', 30', 1h, 2h, 4h, and 6h after the treatment, time which was awarded as sufficient for lowering BP ≤ 140/90 mmHg.Side effects were assessed and the costs were calculated for each patient until normalization of BP.Results: There were significant differences between the groups regarding the age, SBP and DBP values prior to treatment.The age was respectively 57.79±10.98vs 54.34±9.35vs 51.68±9.62 vs 53.66±11.15y,p<0.001.SBP at the start was 185.65±11.
Objective: There are many studies that evalution the risk associated with increase LA volume but echocardiographic criteria aren’t completely in pregnancy hypertension. Design and method: To study whether a temporary condition as enlargement of left atrium is a marker of the severity and chronicity of diastolic dysfunction in pregnancy hypertension. We studied 250 women of the age 29.27(+ 7.29), 34.50(±5.21) week of pregnancy, who had previously been healthy. Left atrium volume, left ventricular geometry, dimensions and function were compared between groups using echocardiography. The LA size is measured at the end-ventricular systole when the LA chamber is at its greatest dimension. Results: To study whether a temporary condition as enlargement of left atrium is a marker of the severity and chronicity of diastolic dysfunction in pregnancy hypertension. We studied 250 women of the age 29.27(+ 7.29), 34.50(±5.21) week of pregnancy, who had previously been healthy. Left atrium volume, left ventricular geometry, dimensions and function were compared between groups using echocardiography. Results; From the analysis of echocardiographic data resulted that women with hypertension during pregnancy had significant altered diastolic function compared to normotensive. Preeclampsia as well as pregnancy hypertension had increased dimension and volume of the left atrium had, increased LVMi with the abnormal geometric pattern of Eccentric hypertrophy, increased diastolic dysfunction, when compared with subjects with normal LV geometry. We found LA volume; (42,32 ± 7,9 ml), LV end-diastolic; (167. 04 ± 28. 53 ml) and end-systolic volume; (67. 88 ± 16. 85 ml), increased during hypertensive pregnancy to normotensive (37,00 ± 4,1, p < 0.001), (151.39 ± 15.64; and 58.36 ± 9. 23; p < 0.001. The significant statistical relation was found between LA volume and Geometric Remodulation as well as Diastolic Dysfunction. The presence of geometric remodulation results in increase of LAV. (r = 0.215, p = 0.001).The increase of LAV results in increase of Diastolic Dysfunction.(r = 0.267, p < 0.001). Conclusions: The data of this study found that, LA volume measurements should become a routine measure during pregnancy because they reflect the burden and chronicity of elevated LV filling pressure and are a strong predictor of future cardiovascular risk in these women
Background: Strain imaging (SI) has been shown to quantify regional myocardial function in both acute ischemic myocardium and infarcted myocardium. The aim of this study is to determine the diagnostic value of SI for the detection of coronary lesions in pts with chest pain, but without apparent wall motion abnormalities. Methods: SI for advanced wall motion analysis was performed in 59 pts with suspicious stable angina (SA) and in 57 pts with suspicious unstable angina (UA), prior to coronary angiography (CAG). Longitudinal strain was measured in 3 apical views. For the identification of ischemia a magnitude parameter, being defined as a reduction of the peak systolic strain, was used. A homogenous pattern of strain was defined as relatively uniform distribution of the peak systolic strain. Heterogeneity of strain was considered abnormal; these segments were called strain (+) and the rest were called strain (-). Results: Out of the 59 SA patients, 28 had >70% stenosis (ischemic-SA) and 31 had normal coronary anatomy or 50% stenosis (normal-SA). Of the 28 patients in the ischemic-SA group, 9 patients (32%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 19 patients (67%) showed heterogeneity of strain (strain positive). 31 patients with normal coronary anatomy or 70% stenosis (ischemic-UA), and 25 had normal coronary anatomy or 50% stenosis (normal-UA). From the 32 patients in the ischemic-UA group, 7 patients (22%) were determined to be strain negative, and 25 patients (78%) were determined to be strain positive. Out of 25 patients with normal coronary anatomy or 50% stenosis (normal-UA), 25 patients (80%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 6 patients (19%) showed heterogeneity of strain (strain positive). The positive predictive value of strain was 80.6% in the UA group. Sensitivity and specificity of 2D strain was evaluated using diagnostic test. The results were: 68% and 80.6% respectively in the stable angina group and 78% and 76% respectively in the unstable angina group.Conclusion: Ultrasound-based SI demonstrates a strong correlation with CAG and it has potential as a non-invasive diagnostic tool for detecting CAD in pts with chest pain and without wall motion abnormalities.
Objective Comparing Lamotrigine versus Lithium efficacy, tolerability, safety in treatment of BPD II. Method 30 female patients,19–60 years old, diagnosed with BPD II according to DSM IV-TR criteria, were enrolled in the study for 24 weeks. HAM-D ≥ 18 and Y-MRS ≤ 10 were used to diagnose depression and hypomania; CGI for severity and improvement. 28 patients analyzed for efficacy, 30 patients for safety. Response to treatment was defined the reduction 50% of values from starting point measured by HAM-D, Y-MRS, CGI-I for values Results After statistical analysis on validity of comparison considering numbers of past episodes,type of actual episode and age, the groups were comparable without significant statistical differences. Lamotrigine and Lithium showed significant efficacy on BP-II ((p = 0.001). They resulted equal efficacious in the treatment of depression and hypomania, for response and remission rate. Was not statistical significant difference between groups on week 8(p = 0,787), 12 (p = 0,124) and 24 (p = 0,348) for Y-MRS, reflecting comparable efficacy on hypomania symptoms. On week 12 six patients(21.2%) resulted in remission with lamotrigine and four (14.3%)with lithium. Statistical analysis showed no difference for dose and time for paroxetine (p = 0.953);(p = 0.701) and lorazepam (p = 0.937);(p = 0.411). Lamotrigine has higher tolerability rate. Side effects prevalence during study period was 12.5% for lamotrigine and 57.14% for lithium groups. Conclusion Lamotrigine and lithium resulted equally efficacious for both episodes of BP-II during acute and maintenance treatment. Lamotrigine manifested less side effects, better compliance.
