BACKGROUND: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. METHODS: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. RESULTS: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. CONCLUSIONS: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02400229.

• Klíčová slova
• Angina, Chest pain, Computed tomography angiography, Coronary artery disease, Health-related quality of life, Invasive coronary angiography,
• MeSH
• angina pectoris klasifikace   diagnóza   patofyziologie   MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen diagnóza   patofyziologie   MeSH
• pilotní projekty MeSH
• průzkumy a dotazníky MeSH
• rozložení podle pohlaví MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pragmatická klinická studie MeSH

The significance of ST-segment changes in an electrocardiogram need not be always as clear-cut as we used to think. Minor problems usually represent only the ST-segment depressions in the presence of typically manifested problems and established coronary artery disease. The same holds true for ST-segment elevations: in addition, they definitively superior to ST-segment depressions. Among other categories, silent ischemia denotes only a part of what is or can be seen. This article deals with other conditions associated with changes in ST segments and variable symptoms with changeable clinical implications.

• MeSH
• angina pectoris diagnóza   MeSH
• elektrokardiografie MeSH
• ischemická choroba srdeční klasifikace   diagnóza   psychologie   MeSH
• lidé MeSH
• psychický stres komplikace   MeSH
• syndrom omráčeného myokardu diagnóza   psychologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• angina pectoris diagnóza   etiologie   chirurgie   MeSH
• aortální chlopeň MeSH
• barevná dopplerovská echokardiografie MeSH
• diferenciální diagnóza MeSH
• echokardiografie transezofageální MeSH
• fibrom komplikace   diagnóza   chirurgie   MeSH
• kardiochirurgické výkony metody   MeSH
• koronární angiografie MeSH
• koronární cévy MeSH
• lidé MeSH
• nádory srdce komplikace   diagnóza   chirurgie   MeSH
• následné studie MeSH
• papilární svaly MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Oxidative stress impairs endothelial function and may play an important role in the pathogenesis of acute cardiovascular diseases. Advanced oxidation protein products (AOPP) were proposed as one of the possible markers of oxidative injury, which originates under oxidative and carbonyl stress and increase global inflammatory activity. The present study was undertaken to compare AOPP concentrations in a control group of healthy individuals without ICHS (I), patients with stable angina pectoris (II), patients with acute coronary syndrome over 48 hours without ST elevations (III), and patients with ST elevation myocardial infarction (IV). Coronaronary angiography, risk factors and anamnestic data were analyzed. We examined 73 probands with signs of myocardial ischemia, mean age of 61.5 years (64% males) subjected to coronarography and 21 healthy individuals. No significant difference was found between venous blood and coronary samples, or between infarction and non-infarction arteries in the group IV. AOPP concentrations in healthy individuals in the group I (82.9 +/- 29.3 mmol/l) did not differ significantly from patients in group II (89.6 +/- 26.7 mmol/l) and group III (112.3 +/- 54.6 mmol/l). A significant difference in AOPP values was found between the groups I and IV, and between the groups II and IV (82.9 +/- 29.3 mmol/l vs. 125.8 +/- 101 mmol/l, p = 0.02, and 89.6 +/- 26.7 mmol/l vs. 125.8 +/- 101 mmol/l, p = 0.02). No correlations were found between AOPP and body mass index (BMI), nicotinism, left ventricular ejection fraction, parameters of glucose and lipid metabolism. ROC analysis revealed that AOPP concentrations of 89 mmol/l had 64% sensitivity and 71% specificity for revealing an acute coronary syndrome (AUC 0.65, 95% CI 0.55-0.80). AOPP are significantly increased in patients with acute coronary syndromes with ST segment elevation, but also tend to increase in patients with non-ST elevation myocardial infarction. Our observations suggest that AOPP may be used as a marker of oxidative stress and as a prognostic factor for severe forms of cardiovascular disease. A cut-off value of 89 mmol/l can be used with 64% sensitivity and 71% specificity for revealing acute coronary syndrome.

• MeSH
• angina pectoris diagnóza   metabolismus   MeSH
• biologické markery krev   MeSH
• infarkt myokardu diagnóza   metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nestabilní angina pectoris diagnóza   metabolismus   MeSH
• oxidace-redukce MeSH
• oxidační stres * MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• biologické markery MeSH

Norman J. Holter attention drew to the possibility to use ambulatory ECG monitoring not only for the diagnosis of arrhythmias but also myocardial ischaemia by already in 1961. It was found that patients with chronic stable angina pectoris have multiple episodes of myocardial ischaemia characterized by transient depressions of the ST segment, very frequently without a clinical correlate. Electrocardiography thus was the first objective method to draw attention to the fact that angina pectoris is associated with approximately one fifth of ischemic episodes of the myocardium in patients with chronic ischaemic heart disease. This was later expressed objectively by further methods which with a different sensitivity and specificity can diagnose current myocardial ischaemia. It was found that developing myocardial ischaemia is gradually manifested within several to tens of seconds by detectable metabolic changes (PET, sampling from the coronary sinus), changes at the level of the microcirculation with impaired perfusion (thalium scan, contrast echocardiography, PET, contrast angiography), impaired diastolic function of the left ventricle (direct assessment of pressures, Doppler echocardiography), regional disorders of left ventricular kinetics (contrast ventriculography, echocardiography, isotope ventriculography). Only after that electrocardiographic signs of myocardial ischaemia develop, in some patients associated with angina pectoris. It is obvious that the diagnosis of myocardial ischaemia by electrocardiographic signs and subjective manifestations is late and not very sensitive.

• MeSH
• angina pectoris diagnóza   MeSH
• elektrokardiografie * MeSH
• ischemická choroba srdeční diagnóza   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Our previous studies (Valová et al. 1992) have dealt with the possibilities of expert system utilization for electrocardiologic data interpretation. The results obtained in these studies provided evidence that the selected probabilistic expert system is suitable for the solution of VCG data interpretation problems. The aim of this paper was to compare the results obtained by stepwise discriminant analysis with that obtained by a probabilistic expert system. These classification methods were applied to VCG data measured by Frank's lead system. Five groups of patients were investigated: 76 healthy subjects, 36 patients with angina pectoris, 112 patients with old posterior myocardial infarction, 107 patients with old anterior myocardial infarction and 35 patients with old anteroseptal myocardial infarction. The classification was carried out by the leaving-one-out technique. Results of the classification obtained in five groups by a probabilistic expert system are evidently better than those obtained by stepwise discriminant analysis.

• MeSH
• angina pectoris diagnóza   MeSH
• diskriminační analýza * MeSH
• expertní systémy * MeSH
• infarkt myokardu diagnóza   MeSH
• lidé MeSH
• pravděpodobnost * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

The highly sensitive and specific thallium scintigraphy is compared to loading electrocardiography with regard to the two crucial parameters: loaded angina pectoris (AP) and horizontal or descendant depression of ST segment of 1.5 mm and deeper (ST). Effectiveness of loading ecg test was determined quantitatively in terms of sensitivity, specificity, prognostic value and test accuracy. Those criteria of positivity of the loading test showed that sensitivity was higher for AP than for ST (73% and 63%, resp.), but specificity was higher for ST (100%) than for AP (79%). The result of thallium test was estimated according to AP occurrence with 80% probability for positive prognosis and 70% probability for negative prognosis; with ST, probability of positive prognosis was 100% and that of negative prognosis was 69%. Test accuracy is 75% for AP and 79% for ST. The 100% probability of positivity of thallium scintigraphy in ST depressions of 1.5 mm and deeper discredits indication of this method in this cases. In the absence of ST depressions, the origin of typical pain during the loading ECG enhances probability of positivity of thallium scintigraphy more than twofold (53 vs. 21%).

• MeSH
• angina pectoris diagnóza   diagnostické zobrazování   patofyziologie   MeSH
• dospělí MeSH
• elektrokardiografie * MeSH
• ischemická choroba srdeční diagnóza   diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prognóza MeSH
• radioizotopy thallia * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tomografie emisní počítačová * MeSH
• zátěžový test * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• radioizotopy thallia * MeSH

Based on data in the literature and his own experience, the author presents modern views on angina pectoris. He discusses anamnestic signs of typical and atypical angina and non-anginous chest pain. He mentions the pathogenesis and clinical picture of stable angina (secondary and mixed angina, syndrome X), unstable angina (mixed and primary angina) and silent ischaemia. As to examinations, he emphasizes in addition to the case-history the importance of the objective finding and stress tests. On the latter indications for invasive examinations are based. The author recapitulates treatment, prognosis an assessment.

• MeSH
• angina pectoris * diagnóza   patofyziologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

In a group of 37 patients with chronic stable angina the authors compared results of bicycle ergometry after a load before and after coronary artery bypass grafting. The group included only patients who had to terminate initial ergometry performed during the last two months before operation on account of stenocardia and signs of myocardial ischaemia on the ECG tracing. On average 20 months after coronary artery bypass grafting ergometry was repeated. Nineteen patients (51%) lacked electrocardiographic signs of myocardial ischaemia, 18 patients (49%) suffered from ischaemia after a load (depression S-T greater than or equal to 2 mm). Of these in 18 patients 8 (44%) no stenocardial attacks were present in another 5 (28%) stenocardia developed only when the depressions were S-T greater than 2 mm. Six patients (33%) had depressions S-T greater than or equal to 3.5 mm at a time when during ergometry they had no complaints and were engaged in similar work loads occasionally also at home. The authors conclude that in the investigated group silent ischaemia after a load was frequent in patients after a coronary artery bypass grafting and frequently it was severe. Patients after coronary artery bypass grafting developed stencardia only after greater S-T depressions than before operation. All patients after coronary artery bypass grafting should be checked by means of loading tests.

• MeSH
• angina pectoris diagnóza   MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• koronární bypass * MeSH
• koronární nemoc diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• zátěžový test * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

173 patients, aged 46.8 years on the average, were examined in the first 3 months after onset of angina pectoris. 97% of them presented at least one of risk factors (smoking, arterial hypertension, overweight, dyslipoproteinaemia), in 79% two or more risk factors were present simultaneously. A greater than 70% stenosis of one coronary artery was present in 51%, in 10% the stenosis was smaller than 70%, in 4% the coronary arteries were intact. In 131 patients without a history of myocardial infarction, vasospastic angina, overweight, and simultaneous presence of 3 or 4 risk factors occurred more frequently than in 42 patients with a history of myocardial infarction. In the first month, complications were registered only in patients with unstable angina pectoris (5 out of 41, i.e., 12%). During the later period of follow-up in 102 patients, complications occurred in 5% and complete clinical remission was registered in 35%. In patients with remission, positive exercise tests and haemodynamically significant stenoses of 2 or 3 coronary arteries were less frequently found on initial examination than in patients with sustained angina pectoris.

• MeSH
• angina pectoris diagnóza   etiologie   patofyziologie   MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• hemodynamika MeSH
• indukce remise MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH