Zbigniew Gasior
Research interests
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InterestsHeart Failure, Hypertension, Echocardiography, Valvular Heart Disease, Congenital Heart Disease
Publications
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1.03Impact points
Low-flow severe aortic stenosis with preserved ejection fraction, N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiovascular remodeling.
The Journal of heart valve disease. 05/2011; 20(3):301-10.
Severe aortic stenosis (AS) with preserved systolic function may coexist with 'low flow' and a lower stroke volume (SV). As the mechanisms of this phenomenon are not fully understood, the study aim was to assess the cardiac and vascular mechanisms of 'low-flow' severe AS with a prese... [more] Severe aortic stenosis (AS) with preserved systolic function may coexist with 'low flow' and a lower stroke volume (SV). As the mechanisms of this phenomenon are not fully understood, the study aim was to assess the cardiac and vascular mechanisms of 'low-flow' severe AS with a preserved left ventricular ejection fraction (LVEF). Forty-four consecutive patients (mean age 69.7 +/- 7.6 years) with severe degenerative AS [mean effective orifice area (EOA) 0.7 +/- 0.3 cm2] and preserved LVEF (> 50%) were enrolled into the study, and allocated to two groups depending on their stroke volume index (SVI) (< 35 and > or = 35 ml/m2, respectively). The clinical data, N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels and ultrasound assessment of LV geometry and function [stroke work (SW), relative wall thickness (RWT)], AS severity, indices of systemic arterial hemodynamics [systemic arterial compliance (SAC), systemic vascular resistance (SVR)] and remodeling [flow-mediated dilatation (FMD), pulse wave velocity (PWV)], as well as valvuloarterial impedance (Z(va)) were analyzed for all study patients. Twenty-four patients (56%; 13 females, 11 males) had low-flow LV output, and 20 (44%; four females, 16 males) had a normal LV output. The mean NT-proBNP serum levels were comparable between the study groups. An analysis of LV remodeling and function revealed a lower LV end-diastolic volume (LVEDV; 85.5 +/- 24.1 versus 160.4 +/- 60.9 ml, p = 0.001), LV end-systolic volume (LVESV; 40.3 +/- 18.5 versus 66.8 +/- 44.2 ml, p = 0.03), LV mass index (LVMI; 150.1 +/- 53.4 versus 183.7 +/- 57.5 g/m2, p = 0.07) and SW (95.6 +/- 23.7 versus 183.2 +/- 50.6 mmHg x ml, p < 0.0001) in the group with SVI < 35 ml/m2. The average RWT was higher in the group with SVI < 35 ml/m2 (48.7 +/- 14.8 versus 40.0 +/- 7.5, p = 0.04). The indices of systemic arterial hemodynamics were significantly different between the groups: the SAC was lower, and the SVR and Z(va) were higher, in patients with SVI < 35 ml/m2 while FMD values were significantly greater in patients with SVI < 35 ml/m2 (11.85 +/- 6.4 versus 7.29 +/- 6.3%, p = 0.035). However, the brachial artery diameter (BAd) was smaller in the latter group, and no differences were found in the FMD x BAd index values. The PWV values were comparable in both study groups. The low-flow phenomenon in severe AS with preserved LVEF is related to smaller LV dimensions, LV concentric hypertrophy, and an increased systemic arterial afterload without differences in plasma NT-proBNP levels. 'Paradoxically' higher values of FMD observed in this population may be associated with a higher proportion of females and a smaller BAd.
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1.03Impact points
Multifocal papillary fibroelastoma of the mitral valve complex and left ventricle wall symptomatic with systemic embolization.
The Journal of heart valve disease. 03/2011; 20(2):240.
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[Risk factors of death or re-hospitalization in acute coronary syndrome patients before and after earlier heart revascularization].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 02/2011; 30(176):97-101.
Cardiovascular diseases including coronary artery disease and its complications--acute coronary syndromes (ACS) are the leading causes of mortality in developed countries. With the growing number of percutaneous revascularization procedures (PCI) patients with at least one prior revascularization pr... [more] Cardiovascular diseases including coronary artery disease and its complications--acute coronary syndromes (ACS) are the leading causes of mortality in developed countries. With the growing number of percutaneous revascularization procedures (PCI) patients with at least one prior revascularization procedure constitute a growing population. The aim of the study was to define the predictors of death and rehospitalization of patients treated for ACS before and after earlier heart revascularization. The study group consisted of 325 patients admitted with the ACS symptoms, 147 patients with prior PCI, 28 patients with former surgical revascularization and 150 patients with no prior coronary artery revascularization procedure. Case-history acquisition, physical examination, ECG, ultrasound echocardiography, coronary angiography and angioplasty of the ACS related vessel as well as the laboratory assessment of morphology, creatinine, sodium, potassium, glucose, troponine I, creatine kinase and its MB isoenzyme serum levels were performed in all cases. The study revealed that cardiogenic shock at the baseline, non-successful PCI procedure, impaired < 45% left ventricle ejection fraction were the independent predictors for death or re-hospitalization due to ACS onset. Even though ACS patients with prior revascularization history have worse echocardiographic parameters which have determined prognostic value, compared with patients with no prior revascularization the prognosis for the 6-month follow-up in both groups remains comparable.
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1.62Impact points
Augmentation of central arterial pressure in adult patients after coarctation repair.
Blood pressure monitoring. 02/2011; 16(1):22-8.
Arterial hypertension and its complications are associated with an increased morbidity and mortality in patients after aortic coarctation (CoA) repair. It is debatable whether early surgery can prevent it. Residual stenosis of descending aorta (AoD) and stiffness in the precoarctation region suppose... [more] Arterial hypertension and its complications are associated with an increased morbidity and mortality in patients after aortic coarctation (CoA) repair. It is debatable whether early surgery can prevent it. Residual stenosis of descending aorta (AoD) and stiffness in the precoarctation region supposedly lead to hypertension. The aim of this study was to evaluate aortic pulse-wave parameters in adult patients after CoA repair and to determine the influence of residual stenosis and age at operation on their values. Eighty-five patients underwent CoA repair (53 males; aged 34.6±10.3 years, age at operation: 10.9±8.2 years). The control group consisted of 30 individuals (18 males; aged 33.6±8.2 years). Augmentation pressure (AP), augmentation index (AI), aortic pulse pressure (APP), and pulse-wave velocity (PWV) were measured with applanation tonometry method. Normotensive patients after CoA repair (47/55%) had higher values of AP (7.3±4.6 vs. 4.4±3.6 mmHg; P=0.002), AI (18.6±10.4 vs. 13.5±4.3%; P=0.03), APP (39.6±8.8 vs. 35.1±9.8; P=0.00001), and PWV (6.8±1.2 vs. 5.4±0.9 m/s; P=0.003) than controls. Forty-six patients presented signs of recoarctation. No significant differences in the systolic blood pressure and diastolic blood pressure, AI and PWV were found between AoD(+) and AoD(-) but AoD(+) had significantly higher APP (46.7±13.8 vs. 38.3±6.9; P=0.001) and AP (10.5±6.9 vs. 7.5±4.1; P=0.02). Significant correlations were found between current age and APP, AP, and AI. No significant correlations were found between central parameters and the age at operation. Normotensive patients after CoA repair have elevated central parameters, related to the residual AoD gradient, regardless of the age at operation. Even early repair cannot prevent progressive vascular impairment in CoA.
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[The importance of resting ECG in diagnosis of coronary heart disease exacerbation and in heart rate disregulations in patients under home palliative care].
Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(1):56-62.
There are large numbers of people suffering from simultaneous coronary heart disease and ischaemic heart disease who remain under home palliative care. When concentrating on oencological palliative treatment, there exists sometimes a tendency to forget about the possibility of deterioration in the g... [more] There are large numbers of people suffering from simultaneous coronary heart disease and ischaemic heart disease who remain under home palliative care. When concentrating on oencological palliative treatment, there exists sometimes a tendency to forget about the possibility of deterioration in the general condition of a patient with cardio-vascular system dysfunctions. Deterioration in the patient's condition and persistent somatic complaints are frequently interpreted as progress in neoplastic disease or side effects of the employed therapy. It frequently leads to unnecessary discontinuation of palliative oencological treatment. Severe general condition of most patients limits the possibility of ischaemic heart disease diagnosis. It is also impossible to perform stress tests. Resting ECG is a simple and relatively inexpensive diagnostic method, possible to be performed at home by the patient's bed. Basing on a medical survey and an analysis of ECG record, diagnosis of deterioration in CHNS is very successful. The management of a patient with advanced neoplastic disease coexistent with ischaemic heart disease demands careful oencological and cardiologic treatment. ECG examinations carried in the patient's bed constitutes a crucial element of diagnostics in deteriorating coronary heart disease and in heart rate disregulations in patients under home palliative care.
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[The impact of prior revascularization procedures on outcome of percutaneous coronary intervention in ACS].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2011; 30(175):10-8.
Development of interventional cadriology is cause of increasing number of acute coronary syndrome (ACS) patients with prior revascularization procedures in the past. To evaluate the clinical feature of ACS patients with and without prior revascularization procedures and to compare in-hospital and lo... [more] Development of interventional cadriology is cause of increasing number of acute coronary syndrome (ACS) patients with prior revascularization procedures in the past. To evaluate the clinical feature of ACS patients with and without prior revascularization procedures and to compare in-hospital and long-term outcome following percutaneous coronary intervention (PCI) in these groups. There were 325 ACS consecutive patients included to the study who underwent PCI procedures. There were 175 patients after PCI or coronary artery by-pass grafting in the past. Control group consisted of 150 subjects with ACS with no history of PCI procedures. We analyzed baseline characteristic as well as the inhospital, 30- and 180-day outcomes. The baseline characteristic revealed higher rate of patients with heart failure in case-history (18.0% vs. 26.9%, p = 0.03), diabetes (16.0% vs. 25.1%, p = 0.04), and multi-vessels coronary disease (85.2% vs. 60.6%, p = 0.003) in the subgroup of prior revascularization. The rate of non-STEMI was higher (28.0% vs. 40.6%, p = 0.02) and the rate of STEMI was lower (47.4% vs. 63.3%, p = 0.004) as a form of ACS in previously revascularized subjects. The analysis of inhospital outcome revealed significantly longer time of hospitalization of the patients with prior revascularization (7.7 +/- 4.6 vs. 5.4 +/- 4.1, p < 0.0001). There were no significant differences in clinical characteristics at 6-months after ACS. Patients undergoing PCI in ACS with prior revascularization procedures are characterized by a higher level of atherosclerosis risk factors, more advanced changes in coronary arteries and higher NSTEMI occurance than ACS patients without PCI history. Baseline and long-term results of revascularization, frequency and nature of complications are comparable in both groups, but length of hospitalization period and significantly longer in patients with revascularization in the past.
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Altered transcriptional activity of gene encoding GAPDH in peripheral blood mononuclear cells from patients with cardiac syndrome X - an important part in pathology of microvascular angina?
Archives of medical science : AMS. 10/2010; 6(5):709-12.
Cardiac syndrome X (CSX) is characterized by anginal pain with ECG suggestive of ischaemia and normal coronary arteries at angiography. Pathology of CSX involves microvascular dysfunction and is possibly linked with metabolic syndrome. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is an enzyme in... [more] Cardiac syndrome X (CSX) is characterized by anginal pain with ECG suggestive of ischaemia and normal coronary arteries at angiography. Pathology of CSX involves microvascular dysfunction and is possibly linked with metabolic syndrome. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is an enzyme involved in glycolysis. The GAPDH gene is a "housekeeping" gene and is used for normalization in quantitative gene expression assays. The aim of the study was to evaluate GAPDH gene expression in CSX. The study was performed in 35 CSX patients and 10 control subjects. mRNA was extracted from peripheral blood mononuclears and the mRNA was assessed by QRT-PCR. GAPDH gene expression was enhanced in CSX patients vs. controls (93022 ±23837 copies/μg vs. 1067 ±240 copies/μg respectively; p < 0.001). Moreover, transcriptional activity of the GAPDH gene was heterogeneous within the CSX group. GAPDH gene expression is markedly enhanced in CSX, which reflects carbohydrate metabolism disturbances and makes the GAPDH gene unsuitable as an endogenous control in patients with CSX.
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Changes in transforming growth factor β and its receptors' mRNA expression in monocytes from patients with acute coronary syndromes.
Archives of medical science : AMS. 08/2010; 6(4):526-32.
Transforming growth factor β (TGF-β) is thought to be a vasoprotective cytokine. Numerous reports confirm its significance in blood and plaques. There is, however, a lack of information on the molecular mechanisms involving TGF-β in circulating inflammatory cells in atherogenesis. sThe aim of the st... [more] Transforming growth factor β (TGF-β) is thought to be a vasoprotective cytokine. Numerous reports confirm its significance in blood and plaques. There is, however, a lack of information on the molecular mechanisms involving TGF-β in circulating inflammatory cells in atherogenesis. sThe aim of the study was to assess gene expression of TGF-β and its receptors in monocytes from patients with acute coronary syndromes (ACS) and the effect of standard treatment on the studied genes. The study was carried out in 32 patients with ACS and 15 healthy subjects. Gene expression of TGF-β and receptors TGF-βRI and TGF-βRII was evaluated on day 1 and 5 in the study group and once in controls. The number of mRNA copies isolated from monocytes was assessed by QRT-PCR. Monocytes of ACS patients showed slightly elevated transcriptional activity of TGF-β1 and its receptors RI and RII genes (0.29 ±0.043 vs. 0.08 ±0.020, p = 0.05; 0.071 ±0.022 vs. 0.036 ±0.023, p < 0.05; 0.134 ±0.020 vs. 0.048 ±0.016, p < 0.05, respectively). After 5-day standard treatment modest reduction of TGF-βRI expression was observed. The studied genes' expression was unrelated to ejection fraction, myocardial necrosis markers, GRACE score, time from the onset of pain to percutaneous coronary intervention and angiographic findings. Among risk factors family history of CAD was associated with increased TGF-βRI expression. Moreover, the presence of 4 or more classic risk factors correlated with higher TGF-βRI expression. Monocytes of ACS patients demonstrate overexpression of TGF-β1 and its receptors' genes. Five-day standard treatment downregulated the TGF-βRI gene but did not affect TGF-β1 and TGF-βRII.
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0.57Impact points
[Percutaneous treatment of periprosthetic valve leak in patients not suitable for reoperation].
Kardiologia polska. 03/2010; 68(3):369-73.
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[Percutaneous coronary intervention effectiveness in acute coronary syndromes in patients over 80 years old--follow-up study].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 02/2010; 28(164):97-102.
Atherosclerosis is a chronic and progressive inflammatory process that causes the most advanced changes in elderly people. In 2006 we published the results of the analysis of acute coronary syndromes in patients after 80 years of age. Conducted the study have decided to extend the observation of dis... [more] Atherosclerosis is a chronic and progressive inflammatory process that causes the most advanced changes in elderly people. In 2006 we published the results of the analysis of acute coronary syndromes in patients after 80 years of age. Conducted the study have decided to extend the observation of distant patients. THE AIM of this study was to assess the effectiveness of remote monitoring percutaneous coronary intervention (PCI) performed in patients with acute coronary syndrome after 80 years of age and to demonstrate the potential benefits of the treatment on the basis of well-being and quality of life of studied patients. The study included 15 women and 16 men aged from 80 to 92 years, which in 2005 because of acute coronary syndrome (ACS) PCI was performed with stenting of coronary vessels. The 31-person group of patients after percutaneous coro-: nary intervention to the end of the observation period 24 patients survived, while seven died. A comparison group of patients living with the deceased showed a number of differences, both clinical as well as the biochemical parameters evaluated. Women accounted for up to 72% among the deceased patients. Moreover, increased posthospitalization mortality in patients with ST elevation myocardial infarction was documented. The majority of patients during the observation period was in class II according to the criteria of the Canadian Society of Cardiology. Analysis of the obtained results in the observation of distant percutaneous balloon therapy with stenting of coronary vessels in patients after 80 years of age showed a majority of respondents declared by the benefit of the treatment administered in the form of improved well-being and quality of life. The analysis of deaths during follow-up period showed the increased mortality during posthospitalization period in patients with ST elevation myocardial infarction and documented the predominance of patients with diabetes and other co-morbidities, especially in women.
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[Effectiveness of heart tumor therapy in the cardiology department during 7 year follow-up]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2009; 27(161):362-7.
Neoplasms of the heart are rare. Usually asymptomatic on the early stage are diagnosed incidentally. Among primary heart neoplasms the most often benign tumors are diagnosed--mostly myxomas, whereas the majority of malignant heart tumors are sarcomas. The aim of this paper was to present heart tumor... [more] Neoplasms of the heart are rare. Usually asymptomatic on the early stage are diagnosed incidentally. Among primary heart neoplasms the most often benign tumors are diagnosed--mostly myxomas, whereas the majority of malignant heart tumors are sarcomas. The aim of this paper was to present heart tumors diagnosed in the cardiology department, their symptoms, used diagnostic tests and therapy and to show after therapy quality of life changes. MATERIAL AND METHODS: There were 18 patients included to the study, whom during hospitalization in the cardiology department heart tumors were diagnosed. There were 11 women and 7 men, aged from 33- to 76-years-old (mean 60,5 years). To all of the patients medical interview, physical examination, EKG, UCG and laboratory test were performed. Additionally in some cases computed tomography or magnetic resonance imaging of the chest and coronary angiograms were done. Based on the diagnostic tests results the patients were qualified to conservative or surgical treatment. RESULTS: Among 18 heart tumor patients in 12 cases primary benign tumors were diagnosed (66,6%), 1 patient had primary malignant tumor (5,5%), there were 3 cases of metastatic tumors (16,6%) and 2 patients with non-neoplasmic tumors--clots (11,1%). From 18 subjects with heart tumor 3 patients died because of advanced stage of neoplasmic disease and presence of metastatic tumors in the heart. CONCLUSIONS: Results of the study show, that heart tumors, regardless of development of diagnostic tests, are still diagnosed too late. The study group follow-up proved, that early diagnosis and proper heart tumor treatment prevented complications and improved the quality of life. It is worth to emphasize, that coronary angiogram in some cases allowed to diagnose coronary artery disease, to treat heart tumor and to perform coronary artery by-pass grafting simultaneously.
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[Expression of genes connected with nuclear factor kappa B (NFkappaB) estimated by oligonucleotide microarray analysis HG-U133A in patients with acute myocardial infarction]
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2009; 27(160):265-72.
Atherosclerosis is a permanently progressive chronic inflammatory disorder which nuclear factor kappaKB (NFkappaB) is involved. Therefore NFkappaB has become integral aspect of atherogenesis and its complications. THE AIM OF THE STUDY: Estimation of genes expression involved in NFkappaB signaling pa... [more] Atherosclerosis is a permanently progressive chronic inflammatory disorder which nuclear factor kappaKB (NFkappaB) is involved. Therefore NFkappaB has become integral aspect of atherogenesis and its complications. THE AIM OF THE STUDY: Estimation of genes expression involved in NFkappaB signaling pathway and separation genes differentiate patients with acute myocardial infarction from healthy subjects. MATERIAL AND METHODS: The examination was assess using the Affymetrix HG-U133A oligonucleotide microarray. Differentiating genes were determined using Bland-Altman graph analysis. Patients wasn't treated due to cardiac diseases before. All patients were subjected to 12-lead ECG, 2-D echocardiography, coronarography and laboratory studies including cardiac troponin, CK and CK-MB. The healthy individuals were subjected to coronarography and computed tomography (calcium score)--coronary artery disease was out of the question. RESULTS: Hierarchical clusterization has demonstrated that the genes expression of patients with acute myocardial infarction was different from healthy individuals. It also demonstrated that the individual groups are homogeneous, especially the group of patients with acute myocardial infarction, regardless of diagnosis, number of risk factors and progression of coronary artery disease. Further Bland-Altman graph analysis showed three important differentiating genes: TLR2, TNFRSF1A i IKBKAP. CONCLUSIONS: Our results confirmed the share of genes involved in NFkappaB signaling pathway in acute complications of atherosclerosis. Noticed differences in genes expression of patients with acute myocardial infarction and healthy subjects can show important role isolated differentiating genes in destabilization of atherogenic plaque and acute myocardial infarction occurrence.
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SERUM IGF-I AND HORMONAL RESPONSES TO INCREMENTAL EXERCISE IN ATHLETES WITH AND WITHOUT LEFT VENTRICULAR HYPERTROPHY
Journal of Sports Science and Medicine. 01/2009;
We investigated the response of insulin-like growth factor (IGF- I), insulin-like growth factor binding protein-3 (IGFBP-3) and some hormones, i.e., testosterone (T), growth hormone (GH), cortisol (C), and insulin (I), to maximal exercise in road cyclists with and without diagnosed left ventricular ... [more] We investigated the response of insulin-like growth factor (IGF- I), insulin-like growth factor binding protein-3 (IGFBP-3) and some hormones, i.e., testosterone (T), growth hormone (GH), cortisol (C), and insulin (I), to maximal exercise in road cyclists with and without diagnosed left ventricular hypertrophy. M-mode and two-dimensional Doppler echocardiography was performed in 30 professional male endurance athletes and a group of 14 healthy untrained subjects using a Hewlett-Packard Image Point HX ultrasound system with standard imaging transducers. Echocardiography and an incremental physical exercise test were performed during the competitive season. Venous blood samples were drawn before and immediately after the maximal cycling exercise test for determination of somatomedin and hormonal concentrations. The basal concentration of IGF-I was statistically higher (p < 0.05) in athletes with left ventricular muscle hypertrophy (LVH) when compared to athletes with a normal upper limit of the left ventricular wall (LVN) (p < 0.05) and to the control group (CG) (p < 0.01). The IGF-I level increased significantly at maximal intensity of incremental exercise in CG (p < 0.01), LVN (p < 0.05) and LVH (p < 0.05) compared to respective values at rest. Long-term endurance training induced an increase in resting (p < 0.01) and post-exercise (p < 0.05) IGF-I/IGFBP-3 ratio in athletes with LVH compared to LVN. The testosterone (T) level was lower in LVH at rest compared to LVN and CG groups (p < 0.05). These results indicate that resting serum IGF-I concentration were higher in trained subjects with LVH compared to athletes without LVH. Serum IGF- I/IGFBP-3 elevation at rest and after exercise might suggest that IGF-I act as a potent stimulant of left ventricular hypertrophy in chronically trained endurance athletes
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0.57Impact points
In-stent coronary restenosis, but not the type of stent, is associated with impaired endothelial-dependent vasodilatation.
Kardiologia polska. 01/2009; 67(1):9-17; discussion 18.
BACKGROUND: Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate. AIM: To compare the long-term effects of the coronary stent implantation - paclitaxel-eluting stent (PES) or bare-met... [more] BACKGROUND: Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate. AIM: To compare the long-term effects of the coronary stent implantation - paclitaxel-eluting stent (PES) or bare-metal stents (BMS) - on endothelial-dependent flow-mediated dilation (FMD), platelet-derived growth factor (PDGF) and asymmetric dimethylarginine (ADMA) serum levels and to assess the relationship between FMD, PDGF, ADMA and every-stage in-stent restenosis (eISR). Methods: The study population included 40 patients with coronary artery disease, who underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) with stent implantation (PES - 21 patients; BMS - 19 patients). Follow-up examination was performed 12 months after PCI. RESULTS: There were no differences between the PES and the BMS patients regarding FMD (PES: 11.8+/-7.8%, BMS: 10.5+/-9.2%), PDGF (PES: 5540+/-2209 pg/ml, BMS: 4923+/-2924 pg/ml) and ADMA (PES: 0.474+/-0.04 micromol/l, BMS: 0.456+/-0.03 micromol/l) serum levels. The follow-up angiography was performed when clinically indicated in 25 patients: in 15 patients with PES and 10 patients with BMS implanted. The eISR was found in 12 subjects: in 7 (47%) with PES and in 5 (50%) with BMS (NS). In all patients with eISR, the FMD values were significantly lower (6.1+/-3.5%, p=0.003) compared to the patients without eISR (14.3+/-7.8%). FMD was the only independent risk factor for eISR (OR=0.631, 95% CI 0.412-0.942, p=0.0003). The cut-off point for FMD < or = 8.4% as a parameter predicting eISR was established (p=0.0001, sensitivity: 83.3%, specificity: 92.3%, PPV: 90.9%, NPV: 85.7%). CONCLUSIONS: The type of stent implanted into LAD does not affect the FMD, PDGF and ADMA serum levels assessed one-year after a PCI procedure. The occurrence of an early in-stent restenosis is associated with impaired FMD at the time of one-year follow-up.
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[Inferior vena cava obstruction in patient with coronary artery disease].
Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2009; 62(3):153-8.
76-year-old male with inferior myocardial infarction and right nephrectomy due to cancer in the past, was admitted to our Department due to incidents of chest pain and syncope. During physical examination we found dilated superficial veins of abdomen, chest and lower extremities. Laboratory tests, e... [more] 76-year-old male with inferior myocardial infarction and right nephrectomy due to cancer in the past, was admitted to our Department due to incidents of chest pain and syncope. During physical examination we found dilated superficial veins of abdomen, chest and lower extremities. Laboratory tests, except creatinine and D-dimer levels were normal. Consulting neurologist excluded neurological reasons of syncope. Holter monitoring showed ventricular extrasystolies and results of transesophageal stimulation of left atrium were normal. Coronary angiogram demonstrated critical stenoses in some of the coronary arteries. Doppler examination showed left femoral vein obstruction. Computer tomography of abdominal cavity demonstrated inferior vena cava obstruction and abdominal wall veins dilatation. Due to thromboembolic disease symptoms pulmonary embolism was suspected. Consulting surgeon and cardiosurgeon decide against surgery due to it's extensive risk, among other things due to possibility of renal function worsening. To prevent embolic complications patient started antithrombotic therapy. Our patient's case shows many vital pathologies in cardio vascular system which occur in one subject. His example demonstrates need to perform multidirectional diagnostics and therapy of such patients.
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0.73Impact points
Serum ADMA concentration-- an independent factor determining FMD impairment in cardiac syndrome X.
Upsala journal of medical sciences. 01/2009; 114(4):221-7.
Mechanisms of decreased endogenous vascular reactivity in individuals with cardiac syndrome X (CSX) are not fully understood. AIM: To evaluate the following serum markers: total nitric oxide (NO), asymmetric dimethylarginine (ADMA), platelet-derived growth factor (PDGF), and to establish their relat... [more] Mechanisms of decreased endogenous vascular reactivity in individuals with cardiac syndrome X (CSX) are not fully understood. AIM: To evaluate the following serum markers: total nitric oxide (NO), asymmetric dimethylarginine (ADMA), platelet-derived growth factor (PDGF), and to establish their relation to ultrasound indexes of endothelial function and structural remodeling in CSX patients. METHOD: The study group consisted of 43 CSX patients (mean age: 56.3 +/- 9 years), while the control group included 21 healthy subjects (mean age: 54.86 +/- 6.9 years). The high-resolution ultrasound was performed to measure: flow-mediated vasodilatation (FMD), nitroglycerine-mediated vasodilatation (NMD) and intima-media thickness (IMT) of carotid arteries. RESULTS: In CSX patients, significantly lower FMD (9.06 +/- 3.2%) and significantly higher IMT (0.667 +/- 0.14 mm) values were observed compared to healthy individuals (17.42 +/- 8.4%, 0.571 +/- 0.2 mm; P < 0.05). Mean total NO serum concentration was significantly higher in the CSX group (48.2 +/- 18.2 micromol/L) as compared to controls (32.1 +/- 1.4 micromol/L; P < 0.0001). There were no differences in serum ADMA and PDGF levels. In CSX patients, FMD values correlated with NO (r = 0.323; P = 0.039) and ADMA (r = -0.387; P = 0.012) serum levels; however, there were no significant correlations between NO and ADMA concentrations. CONCLUSION: Serum ADMA concentration is the only independent factor determining FMD impairment.
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The relationship between cardiovascular risk estimated by use of SCORE system and intima media thickness and flow mediated dilatation in a low risk population.
Cardiology journal. 01/2009; 16(5):407-12.
BACKGROUND: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. METHODS: 119 people (59 me... [more] BACKGROUND: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. METHODS: 119 people (59 men) without known cardiovascular disease and estimated by means of SCORE system risk < 5%, were included in the study. The ultrasound method was used to assess brachial artery diameter (BAd), FMD, nitroglycerin mediated dilatation (NMD) of brachial artery and IMT of common carotid. FMD x BAd and FMD/NMD indexes representing hyperemia-induced vasodilatation independent of brachial artery properties were analyzed. RESULTS: IMT measured was 0.52 +/- 0.08 mm; FMD: 17.5 +/- 7.8%; NMD: 27.0 +/- 9.0%; FMD x BAd: 58.2 +/- 22.4, FMD/NMD: 0.64 +/- 0.19. Independent predictor for both FMD and NMD was BAd (R(2) -0.31; p < 0.001; R(2) -0.44; p < 0.001; respectively), for FMD x BAd index and FMD/NMD index was IMT (R(2) -0.04; p = 0.02; R(2) -0.04; p = 0.015) in a multivariate analysis. Risk estimated by use of the SCORE system was between 0 and 4% (median-1, 25-75 Q: 0-2). A relationship between SCORE risk and IMT (ANOVA p < 0.001), FMD (ANOVA p < 0.001), NMD (ANOVA p < 0.001), FMD x BAd index (ANOVA p = 0.017), but not FMD/NMD index (ANOVA p = 0.27), was found. CONCLUSIONS: The association of a simple stratifying scale (SCORE system) with indices of early vascular remodeling in a low risk population supports its clinical significance.
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1.44Impact points
Diagnostic and prognostic value of rapid pacing stress echocardiography for the detection of coronary artery disease: influence of pacing mode and concomitant antiischemic therapy (final results of multicenter study Pol-RAPSE).
Echocardiography (Mount Kisco, N.Y.). 10/2008; 25(8):827-34.
AIM: Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers according to the pacing mode (AAI/DDD or VVI) and concomitant antiischemic therapy. MATERIAL AND METHODS: 149 rapid pacing stress ec... [more] AIM: Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers according to the pacing mode (AAI/DDD or VVI) and concomitant antiischemic therapy. MATERIAL AND METHODS: 149 rapid pacing stress echo tests were performed in 100 patients (33 females, 67 males, aged 47-79, mean 65 +/- 8 years), utilizing previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during pacing at the rate of 100/minutes and then at 85% of maximal age-predicted heart rate. Each pacing stage lasted for 3 minutes. The test was performed using only VVI pacing mode in 27 patients in whom atrial pacing was not possible. In the remaining 73 patients AAI/DDD pacing mode was initially used in all 73 patients and followed by VVI pacing in 49 patients. Angiographic coronary stenosis of at least 50% was considered significant. RESULTS: No severe adverse effects were observed. Mean duration of the test was 7 +/- 2 minutes for VVI pacing and 10 +/- 2 minutes for both AAI/DDD and VVI pacing. Among 149 tests performed, AAI/DDD mode was used in 73 (49%), while in VVI mode was used in 76 (51%) tests. Significant increase in heart rate comparing to baseline was achieved[[68/minutes vs. 129/minutes (P < 00001)]], also in patients treated with beta-blockers[[69/minutes vs. 129/minutes (P < 00001)]], whereas, blood pressure remained unchanged between rest and rapid pacing stage. Wall motion score index increased significantly (from 1.32 vs. 1.49 in AAI/DDD to 1.36 vs. 1.65 in VVI mode). Among all 149 tests, 89 (60%) were considered positive, 57 (38%) negative, and 3 (2%) - nondiagnostic. Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 91%, 75%, 83%, 81%, and 88%. For AAI/DDD mode the above values were: 91%, 81%, 86%, 82%, 91%, while for VVI mode they were: 91%, 68%, 80%, 80%, 84% (ns). In patients treated with beta-blockers test accuracy was - 79%., with ACE inhibitors - 84%, and with nitrates - 93%. During 1-year follow-up 5 (5%) cardiac deaths and 9 (9,1%) myocardial infarctions occurred. The risk of myocardial infarction or cardiac death was significantly higher in patients with positive comparing to negative result of RAPSE test. Complications hazard ratio associated with positive result of RAPSE was 13.5 (95% confidence interval, 1.7-106.0, P + 0.0133) for AAI/DDD mode and 7.9 (95% confidence interval, 1.0-60.9, P + 0.00472) for VVI mode. CONCLUSIONS: Rapid pacing stress echo test using permanent pacemaker is a rapid and safe diagnostic technique. The accuracy is good for both pacing modes, including tests performed in patients treated with beta-blockers. The test can be utilized as a technique of choice in noninvasive diagnostics of coronary disease and prognostic assessment in patients with permanent pacemakers.
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0.57Impact points
[Constrictive pericarditis in the course of rheumatoid arthritis.]
Kardiologia polska. 09/2008; 66(8):879-84.
We describe a case of a patient with advanced heart failure. On the basis of clinical status, echocardiography and the results of magnetic resonance, constrictive pericarditis was diagnosed. The seropositive rheumatoid arthritis was the cause of the constriction. Constrictive pericarditis should be ... [more] We describe a case of a patient with advanced heart failure. On the basis of clinical status, echocardiography and the results of magnetic resonance, constrictive pericarditis was diagnosed. The seropositive rheumatoid arthritis was the cause of the constriction. Constrictive pericarditis should be considered in differential diagnosis in patients with rheumatoid arthritis and heart failure.
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2.98Impact points
Influence of Gender on Diagnostic Accuracy of Rapid Atrial and Ventricular Pacing Stress Echocardiography for the Detection of Coronary Artery Disease: A Multicenter Study (Pol-RAPSE Final Results).
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 07/2008;
BACKGROUND: Rapid cardiac pacing using a permanent pacemaker may be used as a nonpharmacologic stress during echocardiographic imaging for diagnosing coronary artery disease (CAD). We presented the final results of a national multicenter study, the Polish study on Rapid Pacing Stress Echocardiograph... [more] BACKGROUND: Rapid cardiac pacing using a permanent pacemaker may be used as a nonpharmacologic stress during echocardiographic imaging for diagnosing coronary artery disease (CAD). We presented the final results of a national multicenter study, the Polish study on Rapid Pacing Stress Echocardiography (Pol-RAPSE), aimed at the assessment of the safety and accuracy of rapid cardiac pacing for the noninvasive diagnosis of CAD in women and men. METHODS: We have analyzed 149 tests performed in 100 patients with permanent pacemakers (27% ventricular pacing [VVI], 10% atrial pacing [AAI], 63% dual chamber pacing [DDD]) referred for stress echocardiography. All patients underwent coronary angiography as a reference for assessing the accuracy of rapid cardiac pacing stress echocardiography (RAPSE). Significant CAD was defined as luminal diameter reduction more than 50% in at least 1 major epicardial coronary artery. RESULTS: Peak stress was obtained in 73 patients using physiologic stimulation of right atrium by and mode or in 76 patients by VVI mode. Significant CAD was detected by angiography in 46% of women and 57% of men (P = not significant). The feasibility of the test was 98%. Overall accuracy of the test was slightly lower in women than in men (75% vs 88%, P = .04), although there were no significant differences in sensitivity, specificity, and positive and negative predictive values between the genders. In women (n = 48), the accuracy of RAPSE performed in AAI and VVI mode was 79% and 70% with no significant difference and in men was 89% and 87%, respectively (P = not significant). CONCLUSION: RAPSE is a safe and feasible modality for diagnosing CAD. The method offers slightly higher accuracy in men compared with women. Overall efficacy is satisfactory with both AAI and VVI pacing, although easier interpretation of peak AAI/DDD images results in a trend toward better accuracy.
Following (6)
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Andrzej Kulach
Medical University of Silesia in Katowice -
Andrzej Tykarski
Poznan University of Medical Sciences -
Mieczysław Pasowicz
The John Paul II Hospital in Krakow -
Józefa Dabek
Medical University of Silesia in Katowice -
Jarosław Rydzek
Świetokrzyskie Center of Cardiology
