Background: Coronary artery disease (CAD) represents the most common cause of morbidity and mortality in the Czech Republic. The aim of this study is to analyze long-term cardiovascular diseases (CVD) mortality, identify predictors of outcome and to validate the Framingham risk function in men from the Czech Republic.Design and methods: A 20-year primary prevention study of atherosclerosis risk factors in 1417 men from Prague aged 38-53 years was launched in 1975 (STULONG).Results: When analyzing CVD mortality, heavy smokers had hazard higher than non-smokers and light smokers (p < 0.0001); hypertensives higher than normotensives (p < 0.0001); men with hypercholesterolemia higher than those with normal cholesterol (P = 0.0432), and university-educated men lower than elementary-educated men (p = 0.0006). In 1980-1984, the age specific mortality from CVD in men from STULONG was higher (p = 0.0132) than in the Czech Republic, in 1985-1994 insignificantly lower. The Framingham risk function underestimated the absolute 10-year risk of CAD across the quintile of the risk (p < 0.0001), with 63% discrimination.Conclusion: In STULONG, the mortality from CVD was significantly associated with known risk factors (hypertension, smoking, hypercholesterolemia, education); the Framingham risk function underestimated the absolute 10-year risk of CAD. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

INTRODUCTION:Ischemic Heart Disease (IHD) represents the most frequent cause of mortality and morbidity in the Czech Republic. The aim of this study is to analyze long-term mortality of cardiovascular disease (CVD), identify its predictors and verify the validity of Framingham risk function for Czech patients.DESIGN AND METHODS:The twenty-year study (STULONG) of primary prevention of risk factors of atherosclerosis in 1419 men aged 38 to 53 years living in Prague was started in 1975.RESULTS:CVD mortality analysis showed a higher risk of death for heavy smokers vs. non-smokers or light smokers (p < 0.0001), hypertensive patients vs. patients with normal blood pressure (p < 0.0001), men with hypercholesterolemia vs. men with normal cholesterol level (p = 0.0432), and a lower risk for university graduates vs. men with elementary education (p = 0.0006). Between 1980 and 1984, age-specific CVD mortality rates of men from STULONG study were higher (p = 0.0132) than national CVD mortality rates; between 1985 and 1994, they were insignificantly lower. Framingham risk function underestimated absolute ten-year risk of IHD in all risk quintiles (p < 0.0001) with discrimination of 63%.CONCLUSION:CVD mortality observed within STULONG study was significantly affected by known risk factors (hypertension, smoking, hypercholesterolemia, lower education); Framingham risk function underestimated absolute ten-year risk of IHD.

: Tuesday, June 15, 2004: POSTER SESSIONS: Poster Session 42: Epidemiology and Pharmacoeconomics

Up to 20% to 30% of patients with angina and abnormal stress test have normal coronary arteries at angiography or syndrome X (Sy X). We tested whether body surface potential mapping (BSPM) with intravenous dipyridamole could differentiate patients with Sy X from patients with coronary artery disease (CAD). We compared the effects of intravenous dipyridamole (0.28 mg/kg over 4 min) on BSPM in 17 healthy volunteers (controls) and in 2 groups of patients with angina and abnormal ergometric tests who were referred for angiography: 27 patients with obstructive disease (> or =70% diameter stenosis) in the CAD group, and 17 patients with Sy X. Control subjects were easily differentiated from patients with CAD or Sy X by markedly smaller baseline BSPM DeltaST-T < or = LSD departure areas (P <.001), but the Sy X and CAD groups had similar ST-T departure areas. The average potential integral difference after dipyridamole (APID) differentiated Sy X and CAD patients: the mean APID increased in patients with Sy X and trended negative in the CAD group. The APID(20%-40%) (integrated over 20% to 40% of the ST-T interval) mean value was 0.59 +/- 0.67 microVs in the Sy X group and -0.18 +/- 0.59 microVs in the CAD group (P <.01). At a threshold APID(20%-40%) > 0.17 microVs, the sensitivity and specificity for Sy X was 71% and 78%, respectively; the area under the receiver operating characteristic curve was 0.79 (95% CI 0.64, 0.93). Dipyridamole BSPM is a promising noninvasive diagnostic modality to differentiate patients with Sy X from those with CAD.

First the authors present a review of important cornerstones in the history of the electrocardiogram (ECG) and ECG mapping. The first to describe the electric cardiac field based on twenty ECGs was A.D. Waller in 1889. The decisive cornerstone for practical use was the introduction of a string galvanometer in 1901 by W. Einthoven and his triaxial lead system. Another very important cornerstone in the development of ECG were the findings of F.N. Wilson. Merits as regards the development and application of ECG mapping are due to B. Taccardi. Workers of the Second Medical Clinic in Prague enhanced after 15 years of studies and comparison of ECG maps with coronarographic findings in subjects with ischaemic heart disease (IHD) and microvascular coronary dysfunction (syndrome X--SyX) substantially the specificity of this method in impaired myocardial vascularization. Better diagnosis was achieved by introduction of diagnostic tests which influence coronary vascularization such as e.g. hyperventilation, as well as other tests. After their application progression of chronic myocardial ischaemia occurs, e.g. by the mechanism of the "steal phenomenon" or restriction of the microcirculation after hyperventilation in patients with SyX. Furthermore the authors present examples of ECG maps after PTCA, after application of diagnostic tests in IHD and SyX and also regression of myocardial ischaemia after marked reduction of total cholesterol.

The authors describe the beginnings of development of electrocardiography at the Prague Medical Faculty of Charles-Ferdinand and Charles University resp. The first results of the new method came from the physiological laboratory of Ewald Karl Konstantin Hering (1834-1918), who contributed to electrocardiography by explaining the mechanism of atrial fibrillation and to Richard Hans Kahn (1876-1941) who was the first to publish electrocardiographic changes after temporary block of coronary artery blood flow in the dog. Clinical application and the promotion of electrocardiography in this country is among others in particular from Václav Libenský (1877-1938), Klement Weber (1890-1971) and Frantisek Herles (1900-1991) whose name became for half a century the synonym for electrocardiography.

In the paper we show information theory tools for extracting relevant information for decision support systems from medical databases. Each proposed algorithm for selecting a set of relevant features has a specific score function defined by means of information-theoretical characteristics. Then algorithms are classified according to the primary criterion, that can lead to influence-preferring algorithms or weight-preferring algorithms. Other type of classification can be based on the way of selecting of features as forward, backward or combined algorithms. The software package called CORE (COnstitution and REduction) that supports the process of selection of features relevant for a decision making problem is described. Application on data about 1417 middle age men collected in the twenty years lasting interventional study of cardiovascular risk factors in middle aged men and for decision support in primary care are shown. However, the methodology presented is applicable for any decision making problem where extracting relevant information from data is required.

In the paper we show results of two programs applied for data analysis and decision support in primary preventive study of atherosclerosis. First program E.T. (Epidemiology Tools) can be used for analysis of data from retrospective (case-control) studies, prospective (cohort) studies and for standardization. Second program called CORE (COnstitution and REduction) supports the process of selection of features that are relevant for given decision making task. Program CORE is using information theory approach. Both these programs were applied to analysis of data about 1417 middle age men collected in the longitudinal study on atherosclerosis in urban population. Apart from these two new programs we have analyzed data also by the STATISTICA software.

We describe an analysis of cardiology data using new software tools. First we use data of 1417 men aged 40 to 50 years living in the center of Prague gathered in the twenty years lasting longitudinal study. We show some results of application of the programs E.T. (Epidemiology Tools) and CORE (COnstitution and REduction of data). Second we show the way of application of the program HYPERTENSION, that supports decision making in therapy of arterial hypertension.

Atherosclerosis is a complex, multi-factorial process. It develops over many years without clinical manifestations. Many factors positively or negatively affect its development. The primary prevention strategy involves modification of the so-called risk factors (RF) in those individuals without clinical signs of the disease and covers two approaches. The aim of the population approach is to influence the whole population, especially by changing their life-styles and habits. In the Czech Republic, we have not succeeded in promoting recommendations aimed at decreasing the occurrence and values of atherosclerosis RFs. Therefore, the effort of physicians concentrates more on the detection of people with high risk of atherosclerosis and on influencing their life-style and habits. This study concentrates on detecting and influencing people with a high risk of atherosclerosis. Therefore, the objectives of the study are as follows: to determine the prevalence of atherosclerosis RFs in the urban population of middle-aged men; to follow up the development of the RFs and to assess the possibilities and the influence of complex intervention on the incidence and the values of the RFs and on the incidence of cardiovascular diseases in this population; and to detect coronary artery disease non-invasively by means of body-surface potential mapping (BSPM).

OBJECTIVETo assess the progress of chronic myocardial ischemia after successful percutaneous transluminal coronary angioplasty (PTCA) using body surface potential mapping (BSPM).DESIGNFor BSPM analysis the following kinds of maps were used: isopotential repolarization maps corresponding to 70% of ST-T interval's duration and isointegral maps corresponding to 0% to 20% of ST-T duration. BSPM measurements were taken before the PTCA and usually one to six days after this intervention. In 17 patients BSPM was carried out within two days after PTCA. Eleven to 14 BSPM examinations were usually carried out during six months of follow-up. Control coronary angiography was performed after six months in all but three patients.RESULTSSubstantial focal decrease of positive potential in repolarization caused by myocardial ischemia recovered gradually after successful PTCA. This appeared to be caused by the regression of "hibernating myocardium'. An increase of positive potential was statistically significant (P < 0.01) after the fifth week of PTCA intervention. There was a positive correlation between BSPM findings and chest discomfort of patients after PTCA. Chronic myocardial ischemia could be observed on isopotential and/or isointegral maps examined before the PTCA in 21 of 25 cases (sensitivity 84%).