-
Wojciech Kukwa,
Renata Glowczynska,
Krzysztof J Filipiak,
Andrzej Kukwa, Grzegorz Opolski,
Anna Budaj-Fidecka,
Marcin Grabowski,
Adam Galazka,
Antoni Krzeski,
Monika Kuzminska,
Anna M Czarnecka
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: A high level of endogenous erythropoietin (EPO) may be associated with a smaller infarct size determined by the release of necrosis markers. Sleep-disordered breathing (SDB) is a well-known risk factor for cardiovascular diseases. In contrast, protective effects of SDB have also been described. The potential role of increased levels of EPO and vascular endothelial growth factor (VEGF) is suggested in this process. The study aimed to explore the EPO and VEGF serum levels in SDB and non-SDB patients during the acute phase of myocardial infarction. METHODS: Thirty-seven patients undergoing successful primary percutaneous coronary intervention in the acute myocardial infarction have been examined for the levels of EPO, VEGF, and troponin I (Tn). In the following, patients had an overnight polysomnography to determine breathing disturbances during sleep. RESULTS: Both on admission day (day 1) and day 3 of hospitalization, EPO levels showed statistically significant differences in both SDB-positive and SDB-negative patient groups (p = 0.003 and p = 0.018, respectively). There was no statistically significant difference in VEGF levels. No correlation was found between the EPO and Tn levels. CONCLUSIONS: SDB patients tend to have higher levels of EPO during acute myocardial infarction. No statistically significant differences in VEGF levels were observed.
Sleep And Breathing 01/2013; · 1.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 37 year-old male patient was admitted to the intensive care unit after an out-of-hospital cardiac arrest due to ventricular fibrillation in a course of ST-segment elevation acute coronary syndrome. On admission, the patient was unconscious with a Glasgow Coma Scale (GCS) score of 5. A percutaneous coronary intervention and mild therapeutic hypothermia (HT), defined as maintaining body temperature between 32°C and 34°C, were performed. During HT on ECG, we observed Osborn waves, which resolved spontaneously after re-warming. After five days of recovery, the patient scored 15 on GCS and did not show any neurological deficits.
Kardiologia polska 01/2013; 71(1):88-90. · 0.51 Impact Factor
-
Andrzej Rynkiewicz,
Barbara Cybulska,
Maciej Banach,
Krzysztof J Filipiak,
Tomasz Guzik,
Barbara Idzior Waluś,
Jacek Imiela,
Piotr Jankowski,
Longina Kłosiewicz Latoszek,
Janusz Limon,
Małgorzata Myśliwiec, Grzegorz Opolski,
Andrzej Steciwko,
Janina Stępińska,
Tomasz Zdrojewski
Kardiologia polska 01/2013; 71(1):107-11. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to investigate the association between plasma concentrations of salicylic acid (SA) and other minor acetylsalicylic acid (ASA) metabolites and high on ASA platelet reactivity assessed with different methods in type 2 diabetic patients (T2DM).
Study cohort consisted of 293 T2DM patients on chronic ASA therapy. Platelet function inhibition was analyzed using measurements of serum thromboxane B2 (S-TxB2), VerifyNow Aspirin and Platelet Function Analyzer (PFA)-100 assays. The concentration of ASA metabolites in plasma was measured with a high-performance liquid chromatography (HPLC).
In logistic regression analysis both ASA dose/kg of body weight and plasma SA concentration were found to be predictive of S-TxB2 concentrations above 0.72 ng/mL cut-off point (OR 16.9, 95% CI 2.29-125.8, p = 0.006 and OR 5.34, 95% CI 2.67-10.68, p < 0.001, respectively). When using the VerifyNow Aspirin Assay, the concentrations of SA were signifi - cantly lower (p = 0.007) in the group with high on ASA platelet reactivity when compared with the group with normal on ASA platelet reactivity. In logistic regression analysis plasma SA concentration was found to be predictive of VerifyNow Aspirin Reaction Units (ARU) ≥ 550 (OR 3.86, 95% CI 1.86-8.00, p < 0.001).
Our study suggests that disturbances of pharmacokinetic mechanisms might contribute to lower plasma SA levels, and subsequently incomplete inhibition of thromboxane A2 synthesis as measured with S-TxB2 concentrations and increased platelet reactivity measured with VerifyNow in T2DM patients.
Cardiology journal 01/2013; 20(2):170-7. · 1.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heart failure (HF) is currently one of the main causes of cardiovascular mortality. In order to collect current epidemiological data on patients with HF, the Heart Failure Pilot Survey (ESC-HF Pilot) registry was initiated.
Primary objective of the study was to compare clinical epidemiology of outpatients and inpatients with HF and investigate currently used diagnostic and therapeutic modalities in Poland and 11 other European countries.
The ESC-HF Pilot Survey study was a prospective multicentre observational registry conducted in 2009-2011 in 136 cardiology centres in 12 European countries selected to represent different health systems and care attitudes across Europe. All outpatients with HF and patients admitted due to acute decompensated HF were included into the registry during the enrolment period (1 day per week for 8 consecutive months). Researchers completed detailed medical data questionnaires for all HF patients recruited to the study.
In all participating centres across Europe, 6108 patients were recruited, including 1159 patients from Poland (19% of the survey population). The majority of Polish participants were admitted due to acute HF (73%), while ambulatory chronic HF patients predominated in the remaining European centres (69%). Polish patients develop HF at a younger age compared to other European countries (proportion of patients above 65 years: 54 vs. 65%, respectively) and they are more severely ill (NYHA class III: 44 vs. 34%, respectively; NYHA class IV: 18 vs. 11%; mean BNP level 910 vs. 773 pg/mL). Angiographically documented coronary artery disease was the major aetiology of HF in Poland (39 vs. 33%) which explains a higher rate of invasive revascularisation procedures in the Polish population (13 vs. 7%). In Poland, therapy with implantable cardioverter- -defibrillators was used more frequently during the initial hospitalisation (7 vs. 4%), but the rate of cardiac resynchronisation therapy device implantation was smaller than in other European countries (4 vs. 7%). Drug therapy used in our country was comparable to the rest of Europe, except for more frequent use of aldosterone antagonists. Despite significant differences in the clinical characteristics seen between Polish and other European patients participating in the ESC-HF Pilot study, mortality at 3 months did not differ between Polish and other European centres (2.5 vs. 3%).
The ESC-HF Pilot Survey findings indicate a very high standard of inpatient HF treatment but at the same time unsatisfactory current ambulatory HF therapy in Poland.
Kardiologia polska 01/2013; 71(3):234-40. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves.
To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs.
The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted.
Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN).
The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.
Kardiologia polska 01/2013; 71(3):224-32. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to use genome-wide association approach and pooled DNA strategy to search for new genomic loci associated with inter-individual differences in platelet reactivity in the diabetic patients during acetylsalicylic acid (ASA) treatment. Study cohort consisted of 297 diabetic patients who had been taking ASA (75 mg daily) for at least 3 months. We tested association of single nucleotide polymorphisms (SNPs) genotyped using high density microarray platform with several platelet reactivity assays, followed by individual genotyping of most significant SNPs identified in the microarray genomic scan. The highest statistical significance (p value of 0.0001-0.008 in individual genotyping) was observed for SNP located within the regulatory G-protein signaling (RGS) 7 gene (rs2502448) using recessive genetic model. The diabetic patients on ASA treatment and homozygotes for its minor allele were characterized by increased odds ratio of at 3.45 (confidence interval: 1.82-6.53) for high on ASA platelet reactivity (i.e. impaired ASA response) when compared with homozygotes for wild-type allele. The genome-wide approach might provide an opportunity to identify novel candidate genes and pathways related to platelet activation in diabetic patients.
Journal of Thrombosis and Thrombolysis 10/2012; · 1.48 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bleeding negatively affects prognosis and adherence to antiplatelet therapy after acute coronary syndromes (ACSs). The potential association of on-aspirin platelet reactivity and bleeding is not established. We sought to determine whether low on-aspirin platelet reactivity (LAPR) is associated with bleeding events and antiplatelet therapy compliance in patients with ACSs receiving coronary stenting. On-aspirin platelet reactivity was measured by the VerifyNow™ Aspirin assay (Accumetrics Inc., San Diego, CA, USA) in 531 patients with ACS. Cut-offs for LAPR were calculated by receiver-operating characteristic curve (ROC) analysis. Bleeding was reported according to Bleeding Academic Research Consortium (BARC) definition. The endpoints were minor bleeding (BARC types 1 or 2), major bleeding (BARC types 3 or 5) and antiplatelet therapy cessation during 6-months follow-up. By ROC analysis the VerifyNow™ Aspirin assay was able to distinguish between patients with and without minor bleeding (area under the curve [AUC] 0.66, 95 % confidence interval [CI] 0.62-0.70, P < 0.0001) whereas major bleeding could not be predicted by the assay (AUC 0.54, 95 % CI 0.49-0.58, P = 0.473). By logistic regression, LAPR was associated with increased risk of minor bleeding (odds ratio [OR] 4.32, 95 % CI 2.78-6.71, P < 0.0001) but not major bleeding (OR 2.05, 95 % CI 0.83-5.06, P = 0.117). Antiplatelet therapy discontinuation was more frequent in patients with LAPR as compared to those with no LAPR (21.6 vs. 9.1 %, P = 0.0008). In conclusion, early point-of-care on-aspirin platelet reactivity testing in ACS may identify patients with increased risk of minor bleeding events and subsequent discontinuation of antiplatelet therapy. The possible impact of LAPR on major bleeding needs to be determined in larger trials.
Journal of Thrombosis and Thrombolysis 09/2012; · 1.48 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: New markers of cardiac events and new monitoring methods which can improve care of patients with advanced heart failure (HF) are still being looked for.
Sixty-five patients below 75 years old (mean age: 60.34 ±9.54 years), hospitalized with the first manifestation of HF (left ventricular ejection fraction ≤ 40%) and New York Heart Association (NYHA) class II-IV symptoms, not optimally treated before the study, were included. Blood samples for NT-proBNP and CA-125 were taken at baseline and during the 12-month follow-up period. The doses of β-adrenolytics and angiotensin-converting enzyme (ACE) inhibitors were titrated to maximal tolerated ones according to the guidelines in 1-year follow-up. The endpoint was established as overall death and time to death.
WORSE PROGNOSIS WAS OBSERVED IN GROUPS WITH: 1) NT-proBNP and CA-125 above medians (OR = 492.9, p = 0.006), 2) baseline higher NT-proBNP and CA-125 (HR = 0.016, p < 0.001), 3) increased or stable marker levels during the first 3 months after treatment implementation.
Elevated values of NT-proBNP and CA-125 are found as the independent death risk factors. The group with initial elevated NT-proBNP and CA-125 concentrations had a worse prognosis. Changes in NT-proBNP and CA-125 levels after treatment implementation predict unfavourable cardiovascular events with better CA-125 than NT-proBNP performance.
Archives of medical science : AMS. 09/2012; 8(4):637-43.
-
[show abstract]
[hide abstract]
ABSTRACT: Diabetes mellitus (DM) and coronary artery disease (CAD) are associated with increased cardiovascular risk.
The aim of the study was to compare management of high‑risk patients with DM and patients with CAD in Poland.
Randomly selected primary care offices enrolled patients aged 55 years and older, with DM and no documented CAD (n = 210) or with CAD and no documented DM (n = 186).
Statins were given to 64% vs. 87% (P <0.05), acetylsalicylic acid (ASA) to 53% vs. 84% (P <0.05), and angiotensin‑converting enzyme inhibitors to 70% vs. 69% (P = 0.8) of the patients with DM and CAD, respectively. Screening tests to detect glucose abnormalities in patients with CAD or to detect CAD in patients with DM were not performed in 26% of patients with DM and 24% of those with CAD (P = 0.64). Mean systolic blood pressure was 136.8 ±13.6 vs. 131.7 ±15.8 mmHg (P = 0.001), diastolic blood pressure was 80.4 ±7.4 vs. 79.4 ±11.6 mmHg (P = 0.316), and total cholesterol was 196 ±42 vs. 183 ±42 mg/dl (P = 0.003) in patients with DM and CAD, respectively. The percentage of patients with blood pressure below 140/90 mmHg, total cholesterol below 175 mg/dl, and low‑density lipoprotein (LDL) cholesterol below 100 mg/dl was 15% vs. 25% (P = 0.055), while the percentage of patients with blood pressure below 130/80 mmHg, total cholesterol below 175 mg/dl, and LDL cholesterol <70 mg/dl was 1% vs. 3% (P = 0.016) in the DM vs. CAD groups, respectively.
Use of statins and ASA was more frequent in patients with CAD than in patients with DM. Control of risk factors in the study population was better in the CAD group but still unsatisfactory in most patients.
Polskie archiwum medycyny wewnȩtrznej 07/2012; 122(9):413-21. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background/Aims: The purpose of the present study was to determine the relationship between iatrogenic arterial hypertension or baseline cardiovascular comorbidities and outcomes in metastatic renal cell cancer (mRCC) patients treated with sorafenib. Methods: The study included 148 mRCC patients treated with sorafenib, 63 patients (43%) had preexisting hypertension, 18 patients (12%) coronary artery disease, and 15 patients (10%) mild heart failure. Resting blood pressure (BP) was monitored by clinic and home measurements. Sorafenib-induced hypertension was defined as systolic BP ≥140 and/or diastolic BP ≥90 mm Hg during the first month of treatment. Results: Preexisting cardiovascular comorbidities were not associated with worsening prognosis of patients with mRCC treated with sorafenib. During the first month of treatment, sorafenib-induced hypertension was diagnosed in 76 patients (51.4%), and these patients had a significantly longer PFS (p < 0.00001) and a significantly lower overall mortality risk (p = 0.038). Patients with preexisting and sorafenib-induced hypertension had the longest PFS (p < 0.00001). Conclusions: Sorafenib-induced hypertension is a positive predictive factor in mRCC patients treated with sorafenib, especially in patients with a history of hypertension.
Kidney and Blood Pressure Research 06/2012; 35(6):468-476. · 1.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Severe functional ischemic mitral regurgitation (FIMR) considerably worsens the prognosis of patients after myocardial infarction. The complex pathomechanism of FIMR and its dynamic nature make it difficult to develop effective therapeutic methods.
The aim of the study was to prospectively assess a diagnostic strategy based on stress echocardiography in referring patients with severe FIMR for appropriate surgical procedure: coronary artery bypass grafting alone (CABGa) or CABG with mitral annuloplasty (CABGma) or replacement (CABGmr).
A prospective analysis included 42 patients (23 women, 19 men) aged 67 ±12 years with severe FIMR after myocardial infarction, scheduled for CABG. In each patient, mitral valve morphology, left ventricular function, FIMR degree as assessed by the effective regurgitation orifice area (severe ≥ 20 mm²), myocardial viability, and mitral deformation indexes were assessed prior to surgery. Based on clinical assessment and rest and stress echocardiography parameters, patients were referred for CABGa (group 1; n = 6), CABGma (group 2; n = 27), or CABGmr (group 3; n = 9).
In all study groups, no differences in clinical and echocardiographic results were observed during a 12-month follow-up. A significant improvement was reported in the majority of patients regardless of the surgical procedure. Early (30-day) mortality in the whole study population was 11.9% (n = 5). Survival at 12 months was 100%, 81.5%, and 77.8% for groups 1, 2, and 3, respectively (P = 0.3). In all study groups, a statistically significant FIMR reduction was observed in a 12-month follow-up: small, moderate, and severe FIMR was observed in 29 (83%), 5 (14%), and 1 (3%) surviving patient, respectively. Reverse left ventricular remodeling was observed in 83% of the patients in group 1, 63.7% in group 2, and 100% in group 3 (statistically nonsignificant difference).
The presented diagnostic strategy, based on stress echocardiography, may facilitate the process of choosing a suitable cardiac surgical procedure for patients with severe FIMR.
Polskie archiwum medycyny wewnȩtrznej 04/2012; 122(5):217-25. · 1.37 Impact Factor
-
International journal of cardiology 04/2012; 157(2):274-5. · 7.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Oxidative stress induced by reactive oxygen species (ROS) is considered to play an important part in the aetiology of coronary heart disease. Apart from ROS, neutrophils are a source of neutral endopeptidase (NEP) that inactivates protective natriuretic peptides. The aim of the present study was to evaluate the in vitro ROS generation and inhibition of NEP activity in neutrophils obtained from healthy volunteers and from patients after acute myocardial infarction (AMI) by an aqueous extract of Oenothera paradoxa. Neutrophils isolated from AMI patients showed two-fold higher ROS generation compared with cells from healthy donors, especially in the lucigenin-enhanced luminescence model, which suggests intensive O₂⁻ generation. The addition of O. paradoxa extract at concentrations of 0.2, 2 and 20 µg/mL resulted in a significant reduction in ROS generation. The extracellular NEP activity was higher in patients after AMI compared with healthy individuals (15.0 ± 0.9 versus 10.3 ± 0.5 nmol AMC/10(6) cells/60 min; p = 0.001). The addition of O. paradoxa extract at concentrations of 20, 50 and 100 µg/mL resulted in a significant reduction in NEP activity in both groups. O. paradoxa extract appears to be an interesting candidate for supplementation in the prevention of cardiovascular diseases.
Phytotherapy Research 04/2012; 26(4):482-7. · 2.09 Impact Factor
-
Echocardiography 02/2012; 29(3):E80-1. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: Type 2 diabetes (T2DM) patients are at increased risk of cardiovascular events despite long-term acetylsalicylic acid (ASA) therapy. This study was performed to establish the prevalence of high platelet reactivity (HPR) on ASA in T2DM and to identify its predictors. Methods: The study included 185 T2DM on chronic ASA therapy and to assess platelet reactivity during long-term ASA therapy, we applied the point-of-care method VerifyNow(®) aspirin test (Accumetrics, San Diego, CA, USA). Results: Compared with the low platelet reactivity (LPR) group, patients with HPR had higher triglyceride levels (145 vs. 118 mg/dL, p = 0.041), were less frequently treated with statins (57.1% vs. 75.3%; p = 0.038) and tumor necrosis factor-alpha (TNF-α) concentrations were higher (2.15 vs. 1.74 pg/mL; p = 0.052). In a multivariate analysis only statin therapy (OR 0.375; 95% CI 0.15-0.91; p = 0.030) and lower concentrations of TNF-α (for each 1.0 pg/mL: OR 1.3; 95% CI 1.00-1.72; p = 0.046) were predictive of LPR. Conclusions: Our study provides indirect evidence that the beneficial effect of statins on platelet activity may be related to their non-lipid-mediated, pleiotropic mechanisms of action. This might have been partly related to decreased platelet reactivity in patients receiving statin therapy. In our study in patients with T2DM, platelet reactivity on ASA therapy measured with VerifyNow(®) was associated with TNF-α concentrations and statin therapy. These results may imply a role for subclinical systemic inflammation and a beneficial effect of statins in the development of HPR in T2DM. (Cardiol J 2012; 19, 5: 494-500).
Cardiology journal 01/2012; 19(5):494-500. · 1.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: A number of biomarkers have been found that might help to predict the risk of acute coronary syndrome (ACS) in adults. Aim: To analyse the association between immunoglobulins concentration and other inflammatory markers such as C-reactive protein (CRP) and fibrinogen that show correlation with the risk of ACS. Methods: The study population consists of 52 consecutive patients with ST segment elevation myocardial infarction (STEMI) or unstable angina/non-STEMI. Concentrations of total protein, albumin, alpha-1 globulin, beta globulin, gamma protein, immunoglobulin in class A (IgA), G (IgG), M (IgM) and E (IgE), creatinine kinase (CK), creatinine kinase MB (CK-MB), CRP and fibrinogen were quantified. Results: In the ACS patients, there was a significant increase in gamma globulin, CRP and fibrinogen. IgG was elevated only in the STEMI group and correlated with fibrinogen (R = 0.48, p 〈 0.01). Conclusions: 1. IgG appears to be the only immunoglobulin associated with ACS in the STEMI group. 2. Fibrinogen reveals features of a reactive biomarker of ACS. 3. CRP appears to be closely related to the causative process in coronary artery disease patients.
Kardiologia polska 01/2012; 70(10):1023-8. · 0.51 Impact Factor
-
Kardiologia polska 01/2012; 70(10):1081-1094. · 0.51 Impact Factor
-
Kardiologia polska 01/2012; 70(3):317-20. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Tako-tsubo cardiomyopathy (TTC) is an uncommon transient cardiomyopathy with a clinical and electrocardiographic (ECG) presentation similar to that of ST-elevation myocardial infarction (STEMI).
To compare clinical presentation, in-hospital course, and long-term outcomes in TTC female patients with on-admission ST-segment elevation and anterior STEMI female patients.
Consecutive TTC patients with on-admission ST-segment elevation were selected. Using a propensity score, a matching STEMI control group was put together. The patients were followed for a mean 1,002 ± 552 days. Major adverse cardiac events were defined as TTC recurrence, MI recurrence, heart failure requiring hospitalisation, percutaneous coronary intervention, coronary artery bypass grafting, stroke and death.
Forty one TTC patients were enrolled, including 29 women with on-admission ST-segment elevation. The control group consisted of 46 STEMI women with left anterior descending occlusion. The ECG at presentation showed greater ST- -segment elevation (6.0 ± 1.6 vs 2.0 ± 1.2 mm, p < 0.01) in the control STEMI patients than in the TTC group. Also, baseline CK-MB (16.2 ± 20.6 vs 66.0 ± 125.2 ng/mL, p < 0.01) and troponin-I levels (2.99 ± 5.36 vs 42.70 ± 64.79 ng/mL, p < 0.01) were significantly higher in the STEMI patients. Echocardiography showed higher follow-up ejection fraction in the TTC than in the STEMI group (57.0 ± 8.0 vs 49.5 ± 8.8%, p < 0.01). During follow-up, there was no significant difference in the major adverse cardiac events rate between the TTC and STEMI groups (-24.1% vs 41.3%, p = 0.13).
Although there is some diversity in ECG, laboratory, and ECHO parameters, none of these patterns alone can reliably distinguish TTC from MI in female patients. TTC and STEMI females have similar in-hospital and long-term outcomes.
Kardiologia polska 01/2012; 70(3):233-40. · 0.51 Impact Factor
