Katarzyna Fischer
Research interests
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InterestsAtherosclerosis
Publications
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Diagnosis of early atherosclerotic lesions, and selected atherosclerotic risk factors, in patients with systemic lupus erythematosus.
Polskie archiwum medycyny wewnetrznej. 11/2009; 119(11):736-742.
Early diagnosis of subclinical atherosclerosis can be established using noninvasive imaging techniques, which enable to assess atherosclerotic lesions at different stages of their development, from endothelial dysfunction, through morphological lesions in the arteries, to advanced atherosclerotic pl... [more] Early diagnosis of subclinical atherosclerosis can be established using noninvasive imaging techniques, which enable to assess atherosclerotic lesions at different stages of their development, from endothelial dysfunction, through morphological lesions in the arteries, to advanced atherosclerotic plaques. Given high risk of accelerated development of atherosclerotic lesions in patients with systemic lupus erythematosus (SLE), these techniques should be incorporated in routine diagnostic evaluation in this population. Cardiovascular risk factors in patients with SLE differ significantly from those observed in the general population. Chronic inflammation and the presence of autoantibodies play the key role, while classic risk factors are less important. Subclinical atherosclerotic lesions can be detected in 30% to 40% of the SLE patients. The occurrence of severe symptoms in the cardiovascular and central nervous systems can be caused by such lesions. Recent data indicate that the main causes of death in this patient group represent cardiovascular complications. Early identification of patients in the risk group allows to implement appropriate prophylactic and therapeutic procedures.
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[Risk factors of thickened intima-media and atherosclerotic plaque development in carotid arteries in patients with systemic lupus erythematosus]
Annales Academiae Medicae Stetinensis. 02/2008; 54(2):22-32.
INTRODUCTION: The aim of the study was: (1) The evaluation of the frequency of intima-media thickening (IMT) and the presence of atherosclerotic plaques in carotid arteries in patients with systemic lupus erythematosus (SLE) in comparison with the control group. (2) The evaluation of the correlation... [more] INTRODUCTION: The aim of the study was: (1) The evaluation of the frequency of intima-media thickening (IMT) and the presence of atherosclerotic plaques in carotid arteries in patients with systemic lupus erythematosus (SLE) in comparison with the control group. (2) The evaluation of the correlation between IMT and the presence of atherosclerotic plaques in carotid arteries in patients with SLE and the association of selected immunological and genetic parameters, markers of inflammation, traditional risk factors of atherosclerosis and its treatment. (3) The evaluation of practical usefulness of IMT measurement in diagnostics of early atherosclerosis and the evaluation of risk of its complications in patients with SLE. (4) The evaluation of the correlation between IMT and the presence of atherosclerotic plaques in carotid arteries and selected systemic complications in patients with SLE. MATERIAL AND METHODS: In a group of 103 SLE patients and 30 healthy people (control group) was performed B-mode ultrasound examination of carotid arteries, using HDI 3500 (ATL) with linear transducer 5-12 MHz to evaluate the presence of atherosclerotic changes. There were evaluated traditional risk factors of atherosclerosis, selected autoantibodies and markers of inflammatory reaction, selected genes polymorphism and applied treatment. Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rank Spearman tests. Multivariate regression analysis was also done. RESULTS: Thickened IMT and carotid plaques are significantly more frequent in SLE patients in comparison with the control group (p = 0.0002 and p = 0.0035 respectively). Among traditional risk factors of atherosclerosis hypertension, male gender and age above 45 years were significantly associated with the presence of atherosclerotic changes. The main autoantibodies, which were significantly associated with the risk of the presence of atherosclerotic disorders were as follows: antiprothrombin antibodies (aPTR) in IgA class (OR = 5.5; 95% CI: 1.1-30.2), anti-neutrophil cytoplasmic antibodies (ANCA) directed against elastase (OR = 14.7; 95% CI: 1.4-38.0) and cathepsin G (OR = 10.8; 95% CI: 1.1-126.3) and anti-endothelial cell antibodies (AECA) (OR = 6.6; 95% CI: 1.6-28.3). It was confirmed, that high cumulated dose of glucocorticosteroids is significantly associated with increased risk of development of atherosclerotic changes (OR = 2.4; 95% CI: 1.1-5.5). CONCLUSIONS: (1) The thickening of intima-media and the presence of carotid plaques are significantly more frequent in patients with SLE in comparison with the control group. (2) Systemic lupus erythematosus and antiphospholipid syndrome are risk factors for thickening of intima-media and carotid plaques development. (3) The risk factors of thickening intima-media and carotid plaques development in patients with SLE are selected autoantibodies, inflammatory process and applied treatment. (4) Traditional risk factors of atherosclerosis are not the leading cause of thickened intimamedia and carotid plaques development in patients with SLE contrary to the general population. (5) Measurement of intima-media thickness might be useful in the evaluation of early atherosclerosis and risk of its complications in patients with SLE in routine diagnostics. (6) Thickening of intima-media and the presence of carotid plaques in patients with SLE are associated with significant risk of severe systemic complications, mainly related to cardiovascular and central nervous system.
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[Significance of antiphospholipid syndrome and antiphospholipid antibodies in patients with systemic lupus erythematosus in estimation of risk of subclinical atherosclerosis development]
Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:13-7.
INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations. OBJECTIVES: Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are ris... [more] INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations. OBJECTIVES: Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are risk factors for subclinical atherosclerosis in patients with SLE. PATIENTS AND METHODS: We examined 103 patients with SLE and 30 healthy volunteers, included as the control group. Coexistence of APS was confirmed in 35 patients. Evaluation of subclinical atherosclerosis was done on the basis of measurement of intima-media thickness (IMT) in B-mode ultrasound examination. We considered classical atherosclerotic risk factors and determined profile of aPL: anti-cardiolipine antibodies (aCL), anti beta2 glycoprotein-I antibodies, antiprothrombin antibodies (aPT), anti-oxidized low-density lipoprotein antibodies and lupus anticoagulant (LA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. RESULTS: Thickened IMT was significantly more frequent in patients with SLE than in controls (p = 0.0002). We found that coexistence of APS is a risk factor for moderate thickening of IMT (OR: 3.41; 95% CI: 1.0-11.5). We also confirmed that the presence of aPL is significantly correlated with IMT ranging from 0.66 to 0.86 mm. The highest risk was found in patients with the presence of aPT IgA (OR: 5.50; 95% CI: 1.1-30.2), aCL IgM (OR: 4.36; 95% CI: 1.1-20.7), LA (OR: 4.02; 95% CI: 1.1-19.4) and aCL IgG (OR: 2.99; 95% CI: 1.1-9.7). Moreover, we found that ischaemic heart disease, nephropathy and myocardial infarction were significantly more frequent in patients with thickened IMT. CONCLUSIONS: Patients with SLE develop subclinical atherosclerosis significantly more frequent than the general population. Coexistence of APS and presence of aPL are risk factors for subclinical atherosclerosis development in patients with SLE. Thickened intima-media in patients with SLE is significantly associated with an increased risk of cardiovascular manifestations.
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[Antiphospholipid syndrome and antiphospholipid antibodies as a risk factors of ischaemic heart disease and myocardial infarction in patients with systemic lupus erythematosus]
Polskie archiwum medycyny wewnȩtrznej. 06/2006; 115(5):407-13.
Ischemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodies are the risk factor for myocardial infarction and ischemic heart disease in patients with TRU. We ex... [more] Ischemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodies are the risk factor for myocardial infarction and ischemic heart disease in patients with TRU. We examined 129 patients with SLE (114 women and 15 men). All the patients underwent comprehensive physical examination. ECG, ultrasound heart examinations were performed. They were followed by heart scintygraphic examination if indicated. Routine biochemical and hematological laboratory tests were performed including fasting glucose level, concentration of homocysteine, uric acid and lipids. Wide range of immunological essays were performed, testing for antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), antiphospholipid antibodies (anticardiolipin antibodies--aCL, lupus anticoagulant--LA, antiprothrombine antibodies aPT, anti-beta2glicoprotein-I antibodies), anti-dsDNA antibodies, anti-nucleosome antibodies, antihistone antibodies, antineutrophil cytoplasmic antibodies (ANCA) and antiendothelial antibodies (AECA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. Ischemic heart disease was found in 20 (15.5%) SLE patients, myocardial infarctions were diagnosed in 9 (6.97%). Ischemic heart disease and myocardial infarction were significantly related to presence of secondary antiphospholipid syndrome (SAPS), OR: 4.21, p = 0.008 and OR: 12.8; p = 0.02 respectively). They were also related to high activity of SLE, OR: 7.18; p = 0.012 and OR: 27.3; p = 0.006 respectively. Ischemic heart disease was significantly more common in older patients (52.75 years versus 42.15 years; p = 0.0008) and in patients with hypertension (p < 0.05). Impaired glucose tolerance (OR: 8.44; p = 0.03), presence of aCL IgG (OR; 2.93; p = 0.05) and p-ANCA anti-MPO (OR: 6.08; p = 0.036) were found to be risk factors of ischemic heart disease. Myocardial infarction was significantly associated with high uric acid level (OR: 5.01; p = 0.052) and impaired glucose tolerance (OR: 7.42; p = 0.047) and with presence of the following antibodies: aCL IgG and/or aCL IgM (OR: 5.61; p = 0.039), ANCA in the indirect immunofluorescence essay (OR: 5.78; p = 0.035), anti-MPO antibodies (OR: 6.58; p = 0.051) and AECA (OR: 11.10; p = 0.026). Presence of antiphospholipid antibodies and SAPS are significant risk factors of ischemic heart disease and myocardial infarction in SLE patients. The risk factors of ischemic heart disease and myocardial infarction in SLE patients significantly differ from the ones in general population.
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[Cardiovascular abnormalities in systemic lupus erythematosus patients in echocardiographic assessment]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2006; 20(117):305-8.
Cardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLE patients with a regard to clinical, serological and environmental risk factors. MATERIAL AND METHODS:... [more] Cardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLE patients with a regard to clinical, serological and environmental risk factors. MATERIAL AND METHODS: 103 patients were included into the study, 91 women and 12 men, aged 16-74 yrs, the control group included 25 subjects. Physical examination, two-dimensional guided M-mode and Doppler echocardiographic recordings were performed. The tests for the presence of ANA, ENA, antiphospholipid antibodies (aCL, LA, anti-beta2GPI and antiprothrombin antibodies), ANCA (anti-neutrophil cytoplasm antibodies), AECA (anti endothelial cell antibodies) were carried out. RESULTS: The following pathologies were significantly more common in the SLE patients: pericardial involvement (58%), organic changes of the mitral valve cusps (54%), organic changes of the aortic valve cusps (36%), widening of the aortal lumen (35%), enlargement of the left atrium (18%), hypokinesis of the left ventricle myocardial muscle (15%). Ultrasound cardiac pathologies were associated with presence of antiphospholipid antibodies, ANCA, anti-hitone antibodies and AECA. High activity of SLE increased risk of pericarditis and ascending aortic wall thickening. Cardiovascular manifestations occurred most frequently in patients with short time duration of SLE. CONCLUSION: Cardiac involvement is a frequent and early systemic complication of SLE and it is the most commonly related to pericardium and valvular apparatus. Cardiovascular manifestations in SLE patients are the most frequently related to the presence of serological risk factors, mainly antiphospholipid antibodies. It suggests their major role in the pathogenesis of the cardiovascular involvement in SLE. Pericarditis are markers of high activity of SLE.
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[Antiendothelial cell antibodies as a risk factor of atherosclerosis in systemic lupus erythematosus]
Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:95-9.
PURPOSE: It was confirmed experimentally that antiendothelial cell antibodies (AECA) react directly with the vascular endothelium and are involved in the pathogenesis of vasculitis. There is evidence for a role of AECA in atherosclerosis. To search for correlations between intima-media thickness (IM... [more] PURPOSE: It was confirmed experimentally that antiendothelial cell antibodies (AECA) react directly with the vascular endothelium and are involved in the pathogenesis of vasculitis. There is evidence for a role of AECA in atherosclerosis. To search for correlations between intima-media thickness (IMT) and high titer of AECA in patients with systemic lupus erythematosus (SLE). MATERIAL AND METHODS: IMT of carotid arteries was measured with B-mode ultrasound in 103 SLE patients and 30 healthy subjects (control group). The presence of AECA was determined with indirect immunofluorescence using human umbilical vein endothelial cells as target. Statistical analysis was performed with chi2 Yates, chi2 Pearson, R Spearman rank test, and logistic multivariate regression analysis. RESULTS: Normal IMT (< or = 0.65 mm) was found in 34 patients. In 52 patients, IMT was 0.66-0.86 mm and in 17 it exceeded 0.86 mm. The difference in comparison with the control group was significant (p = 0.0002). High titers of AECA were significantly more frequent in patients with SLE than in controls (p = 0.0001). In SLE patients, high titers of AECA correlated with IMT greater than 0.86 mm (OR = 6.61; 95% CI: 1.6-28.3). CONCLUSIONS: The presence of antiendothelial cell antibodies is a risk factor for premature, subclinical atherosclerosis in patients with SLE.
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1.54Impact points
Value of high resistance index - HRI calculated from Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE).
Medical science monitor : international medical journal of experimental and clinical research. 07/2004; 10 Suppl 3:58-62.
Background: HRI is a new Doppler index calculated as a ratio between S -maximal systolic flow and D -maximal early diastolic reversed flow -HRI=D/S. The aim of the study is to evaluate the diagnostic significance of HRI calculated from the Doppler spectrum of popliteal arteries in patients with syst... [more] Background: HRI is a new Doppler index calculated as a ratio between S -maximal systolic flow and D -maximal early diastolic reversed flow -HRI=D/S. The aim of the study is to evaluate the diagnostic significance of HRI calculated from the Doppler spectrum of popliteal arteries in patients with systemic lupus erythematosus (SLE) with and without secondary antiphospholipid syndrome (SAPS) compared with healthy controls. Material/Methods: During 9-month period (May 2003 -January 2004), 93 patients (81 women and 12 men) with SLE (including 24 patients with SAPS) and 30 healthy controls (24 women and 6 men) underwent bilateral duplex Doppler examinations of lower limb arteries. The examinations were performed using HDI 3500 (ATL) with 5 -12 MHz linear transducer under standardized conditions: correct insonation angle and sample volume size, with the patient in a supine position, after 10 minutes rest. Results: Mean HRI value obtained in the control group was 0.415 (range 0.305 -0.555; median 0.402). In the group of SLE patients without SAPS, mean HRI value was decreased to 0.320 (range 0 -0.584;median 0.334) and even lower -0.283 in SLE patients with SAPS (range 0.106 -0.545; median 0.291). Conclusions: Small arteries, arterioles and capillaries are the main affected vessels in SLE. This chronic process stimulates circulation through lower resistance collaterals, decreasing HRI value. The Doppler HRI calculation can be valuable in early diagnosis and monitoring of lower extremity vascular changes in patients suffering from SLE with and without SAPS.
Following (1)
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Katarzyna Fischer
Pomeranian Medical University in Szczecin
Topics (1)
