Mariola Cieśla-Dul

Publications of Mariola Cieśla-Dul

• Abnormal plasma fibrin clot characteristics are associated with worse clinical outcome in patients with peripheral arterial disease and thromboangiitis obliterans.

  Authors: Anetta Undas, Tomasz Nowakowski, Mariola Cieśla-Dul, Jerzy Sadowski

  Atherosclerosis. 01/2011; 215(2):481-6.

  A role of blood coagulation in the pathogenesis of peripheral arterial disease (PAD) and Buerger's disease, or thromboangiitis obliterans (TAO), remains unclear. To test the hypothesis that PAD andA role of blood coagulation in the pathogenesis of peripheral arterial disease (PAD) and Buerger's disease, or thromboangiitis obliterans (TAO), remains unclear. To test the hypothesis that PAD and TAO are associated with prothrombotic phenotype of a fibrin clot. Ex vivo plasma fibrin clot permeability, turbidimetry and efficiency of fibrinolysis were investigated in 106 patients with PAD and 20 patients with TAO and compared with the respective control groups matched for age, sex, and cardiovascular risk factors. The progression of PAD and TAO were evaluated during follow-up of 3-7.5 years. PAD patients were characterized by lower clot permeability (-18.8%, p=0.005), shorter lag phase (-35.3%, p<0.001), higher maximum clot absorbancy (+22.4%, p<0.001), prolonged clot lysis time (+30.6%, p=0.003), and lower rate of D-dimer release from clots in the presence of recombinant tissue plasminogen activator (-16.5%, p=0.009), but twofold lower maximum D-dimer levels released from clots during lysis (p<0.001) than the controls. Similar, but more pronounced abnormalities were observed in TAO patients versus controls (all p<0.01). Seventeen PAD (16%) and 3 (15%) TAO patients were lost to follow-up. The progression observed in 47 (52.8%) PAD patients and 10 (59%) TAO patients was associated with lower clot permeability (-14.6%, p=0.009, and -17.5%, p=0.02) and prolonged clot lysis (+11.3%, p=0.004, and +12.4%, p=0.03, respectively). Unfavorably altered fibrin clot properties are observed in both PAD and TAO. Denser fibrin clots with reduced susceptibility to lysis might characterize the progression of both diseases during long-term follow-up.

• Association between selected risk factors and the incidence of venous obstruction after pacemaker implantation: demographic and clinical factors.

  Authors: Jacek Lelakowski, Teresa Barbara Domagała, Mariola Cieśla-Dul, Anna Rydlewska, Jacek Majewski, Justyna Piekarz, Katarzyna Kotula-Horowitz, Jerzy Sadowski

  Kardiologia polska. 01/2011; 69(10):1033-40.

  Venous obstruction and subsequent pulmonary embolism belong to the most common and dangerous complications of pacemaker implantation. Thus, identification of patients at risk of venous obstructionVenous obstruction and subsequent pulmonary embolism belong to the most common and dangerous complications of pacemaker implantation. Thus, identification of patients at risk of venous obstruction seems to be of critical importance. To determine risk factors of venous obstruction following pacemaker implantation. Eighty one patients with permanent cardiac pacing (31 F, 50 M; mean age 71.1 ± 7.6 years) were included. Prior to pacemaker implantation, the following factors were evaluated in each patient: indications for pacemaker implantation, heart failure severity assessed using the NYHA classification, coexisting diseases, a history of tobacco smoking, medications used before the procedure (antiplatelet drugs, anticoagulants, antibiotics), a history of thrombotic or infectious complications, and previous temporary cardiac pacing. Type of venous access and procedure time were also assessed. Venous ultrasound examination to evaluate veins in both upper extremities, shoulder areas and the neck was performed before pacemaker implantation and 6 and 12 months following the procedure. Computed tomography and conventional digital subtraction angiography were performed to confirm the diagnosis of venous obstruction. The patients were divided into two groups based on the occurrence of venous obstruction after pacemaker implantation. Group I (n = 71, 29 F, 42 M; mean age 71.0 ± 7.7 years) included patients without venous obstruction, and group II (n = 10, 2 F, 8 M; mean age 71.6 ± 7.0 years) included patients diagnosed with venous obstruction. Each patient was followed for 19 months. In group II (12.3% of the study population), venous obstruction developed mean 13 months after pacemaker implantation. In this group, symptomatic venous obstruction was observed in 3 patients (3.7% of the study population), mean 15 months after pacemaker implantation. Risk factors for venous obstruction included a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, NYHA class III and IV heart failure, a history of infection, and tobacco smoking. Depending on the number of risk factors, the probability of development of venous obstruction was described by the following equation: e(-14.6 + 3.19x)/1 + e(-14.6 + 3.19x), where x is the number of risk factors. In patients who had more than 6 risk factors, almost a 100% probability of the occurrence of venous obstruction was observed. 1. Risk factors for venous obstruction include a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, infections, NYHA class III and IV heart failure, and tobacco smoking. 2. In patients who had more than 6 risk factors, almost a 100% risk of venous obstruction was observed.

• Residual iliofemoral thrombosis in a 31-year-old woman on oral contraceptives possessing heterozygous factor V Leiden, factor XIII Val34Leu allele and alpha-fibrinogen Thr312Ala allele: case report.

  Authors: Mariola Cieśla-Dul, Bogusław Gaweda, Ewa Wypasek, Maria Rózańska, Jerzy Sadowski

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):822-5.

  We present the case of a 31-year-old woman on oral contraceptives with a 3-year history of iliofemoral thrombosis resistant to recanalization despite satisfactory anticoagulation therapy and absenceWe present the case of a 31-year-old woman on oral contraceptives with a 3-year history of iliofemoral thrombosis resistant to recanalization despite satisfactory anticoagulation therapy and absence of concomitant diseases. Thrombophilia screening revealed heterozygous factor V Leiden mutation. We also detected the presence of factor XIII (FXIII) Leu34 allele and alpha-chain fibrinogen 312Ala allele, which are known to adversely affect fibrin clot structure and lysis. It might be speculated that the presence of 3 polymorphisms in this patient could contribute to proximal thrombosis resistant to treatment. We postulate that determination of FXIII and alpha-fibrinogen polymorphisms can be useful in the evaluation of some young patients with deep vein thrombosis.

• Switching from acenocoumarol to warfarin in patients with unstable anticoagulation and its effect on anticoagulation control.

  Authors: Anetta Undas, Mariola Cieśla-Dul, Marek Zółciński, Wiesława Tracz

  Polskie archiwum medycyny wewnȩtrznej. 06/2009; 119(6):360-5.

  INTRODUCTION: Unstable oral anticoagulation increases the risk of thrombotic events and bleedings. Acenocoumarol use has been reported to be associated with two-fold higher risk for instability ofINTRODUCTION: Unstable oral anticoagulation increases the risk of thrombotic events and bleedings. Acenocoumarol use has been reported to be associated with two-fold higher risk for instability of anticoagulation control compared to warfarin administration. OBJECTIVES: The aim of the study was to evaluate the effect of introducing warfarin on anticoagulation control in patients with a variable response to acenocoumarol. PATIENTS AND METHODS: Sixty-eight subjects treated with acenocoumarol for 5 months or more and displaying intraindividual variability of international normalized ratio (INR) results were switched to warfarin. Unstable anticoagulation was defined as a failure to achieve a target INR within the preceding 3 months, i.e. > or = 50% of 8 or more INR values below 2 or above 3.5. Patients with stable anticoagulation (<20% of out-of-range INRs), matched for age, gender, and anticoagulation indications, served as a reference group. RESULTS: Patients with unstable anticoagulation on acenocoumarol had higher body mass index (p<0.01) and serum C-reactive protein levels (p<0.01) compared to stable counterparts. The transition factor between acenocoumarol and warfarin was 1.8 (95% CI 1.69-1.96). The percentage time within the target INR range in patients with unstable anticoagulation was 40.2% at baseline and increased to 60.4% following 6 months on warfarin therapy (p<0.05). The number of subjects with <20% of out-of-range INRs among individuals switched from acenocoumarol to warfarin was 22 (32.4%) vs. 63 (92.6%) in patients on stable anticoagulation after 6 months of follow-up (p<0.001). CONCLUSIONS: Switching acenocoumarol to warfarin in patients with unstable anticoagulation can improve anticoagulation control.

• [Low ejection fraction as risk factor after aortic valve replacement]

  Authors: Mariola Cieśla-Dul, Roman Pfitzner, Rafał Drwiła, Izabela Górkiewicz-Kot, Jerzy Sadowski

  Przegla̧d lekarski. 02/2004; 61(6):579-84.

  The aim of the study is to estimate the operative risk of aortic valve replacement for severe aortic valve stenosis in patients with distinctly impaired left ventricular function (ejection fractionThe aim of the study is to estimate the operative risk of aortic valve replacement for severe aortic valve stenosis in patients with distinctly impaired left ventricular function (ejection fraction below 40%). From the population of 2512 pts, who underwent aortic valve replacement in the years 1990 to 1999 because of acquired malformation, a group of 108 pts (4.3%), fulfilling the above mentioned conditions was selected. Between them prevailed men, 92 (85.2%), and the average age was 53.4 +/- 14.5. All pts remained in the NYHA functional class III/IV. The average ejection fraction was estimated 28.2 +/- 14.3%. The pts demonstrated concentric left ventricular hypertrophy, severe aortic valve calcifications, the average valvular area was 0.91 cm2, and the pressure gradient over the valve was 71 +/- 44 mmHg. The pts were operated on by different surgeons but after the same protocol of extracorporeal circulation and cardioplegia administration. Low output syndrome occurred in ca 40% of pts, and cardiac failure was the main cause of death. The hospital mortality was 8.6%, and it was over two times higher then the whole population of pts, who underwent aortic valve replacement. All survivors (91.4%) demonstrated clinical improvement already during the early observation. Conclusions: Low ejection fraction is an important risk factor of surgery for aortic valve stenosis. However, the elevated operative mortality, comparable to other institutions, may be accepted taking for consideration, that surgery is the only way of treatment and improvement may be expected in about 90% of pts, including anatomical and hemodynamic parameters, as well as life longevity and comfort. In the extreme cases the HTX should be considered.

• [Asymptomatic carotid stenosis: ACS]

  Authors: Mariola Cieśla-Dul, Dorde Radak, Roman Pfitzner, Maria Sniezek-Maciejewska

  Przegla̧d lekarski. 01/2003; 60(3):151-5.

  Asymptomatic carotid stenosis (ACS) is the lesion located in the vicinity of the common carotid artery branching, without neurological symptoms caused by insufficient blood flow to the brain.Asymptomatic carotid stenosis (ACS) is the lesion located in the vicinity of the common carotid artery branching, without neurological symptoms caused by insufficient blood flow to the brain. Cerebrovascular diseases represent an important medical as well as social problem, since this is one of the leading causes of mortality and serious invalidity worldwide. Majority of brain insults are caused by stenosing atherosclerotic lesions of the carotid arteries. Thus, early surgical treatment may contribute to lessen this problem. Routine diagnosis of ACS include auscultation and ultra-sonographic examination of carotid arteries. Early detection of the disease enables proper medical prophylaxis and decision for surgical treatment (providing that expected benefit for the patient exceeds possible operative risk, i.e. < 3% of complication rate in experienced surgical wards). That's why of particular importance is to formulate multidisciplinary programs of insult prevention and to conduct multiinstitutional studies in order to establish clear cut indications for surgical treatment, particularly for the group of asymptomatic patients.