Stefan Grajek

Poznan University of Medical Sciences, Posen, Greater Poland Voivodeship, Poland

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Publications (199)345.05 Total impact

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    ABSTRACT: The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions.
    European review for medical and pharmacological sciences. 08/2014; 18(15):2169-75.
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    ABSTRACT: Cardiac pseudoneoplasms are rare and benign. According to WHO they are classified as tumor-like lesions. We report two patients with recurrent ventricular tachycardia (VT) in whom magnetic resonance imaging revealed a pathological mass occupying a large part of the left ventricle. The localization of both tumors precluded the possibility of resection, thus only surgical biopsy was performed. After deducting the prospect of malignancy of the tumors we treated both patients with amiodarone and implantation of a cardioverter-defibrillator (ICD). VT is one of many probable symptoms indicating a tumor within the heart, therefore treatment with an ICD should only be considered after a more thorough diagnosis.
    Cardiovascular Pathology. 08/2014;
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    ABSTRACT: Histamine is a mediator, which increases the permeability of capillaries during the early phase of allergic reaction, causes smooth muscle contraction of bronchi and stimulates mucous glands in the nasal cavity. Antihistamines are the basis of symptomatic treatment in the majority of allergic diseases, especially allergic rhinitis, allergic conjunctivitis, urticaria and anaphylaxis. The cardiotoxic effects of the two withdrawn drugs, terfenadine and astemizole, were manifested by prolonged QT intervals and triggering torsades de pointes (TdP) caused by blockade of the 'rapid' I Kr potassium channels. These phenomena, however, are not a class effect. This review deals with a new generation of antihistamine drugs in the context of QT interval prolongation risk.
    Postepy Dermatologii I Alergologii 06/2014; 31(3):182. · 0.66 Impact Factor
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    ABSTRACT: Remodeling and impaired blood flow in left atrial appendage (LAA), which occurs in patients with atrial fibrillation, may lead to thrombus formation and possible thromboembolic complications. Although there are several pharmacological antithrombotic possibilities, some patients with several co-morbidities and contraindications to such treatment cannot be offered any of them - LAA closure systems may be an attractive alternative. We present our early experience with two currently available different LAA transcatheter closure systems (Watchman and Amplatzer Cardiac Plug). Twenty three patients (mean age 69,1±6,8 years, 12 male) with nonrheumatic atrial fibrillation and high risk of thromboembolic complications (CHA2DS2VASc score ≥ 2 (mean 4,5±1,5), who could not be treated with the longterm oral anticoagulation because of contraindications or significant side effects, were qualified to the LAA closure. The Amplatzer Cardiac Plug (St Jude Medical) was implanted in 7 patients and Watchman Occluder (Boston Scientific, Boston, MA) in the other 15 patients. The implantation was not performed in one patient as the transoesophageal echocardiography during the procedure revealed a new thrombus in LAA. The procedural details and followup data are presented. Neither severe pericardial effusion nor device related thrombus were observed. In long term follow-up transient ischemic attack was noted only in one patient (diagnosed with thrombophilia). One patient died 14 months after the procedure due to non-cardiac reason. The LAA occluder implantation seems to be a safe and reasonable alternative for oral anticoagulation and should be considered in patients with atrial fibrillation who have contraindications or complications of pharmacological treatment.
    Minerva cardioangiologica. 04/2014;
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    ABSTRACT: Abstract Due to expansion of the pharmaceutical market it seems necessary to prove the efficacy of the generic drugs. The aim of this study is to compare the effects of two clopidogrel formulations: brand-name-Plavix and generic drug - Egitromb. This is a prospective, randomized study comparing two groups of patients treated with two clopidogrel: brand-name Plavix and generic drug- Egitromb. The 53 consecutive patients with stable coronary artery disease qualifying for coronary angiography and PCI were enrolled in this trial. They were randomized into two groups. In the group A (n = 28) patients received Egitromb 300 mg at admission followed by 8 days of 75 mg Egitromb daily. In the group B (n = 25) patients received Plavix 300 mg on the admission followed by 8 days of 75 mg Plavix maintenance therapy. Blood samples for multiple electrode aggregometry testing were drawn at baseline, 5 hours and 8 days after taking the loading dose. Median values of platelet aggregation inhibition did not differ between the Plavix and Egitromb groups when assessed at baseline: 239AU/min (IQR:329) vs. 209 (IQR:406; p = 0.894), 5 hours after loading: 183 AU/min (IQR:107) vs. 165 (IQR:171; p = 0.831) or at day 8: 174 AU/min (IQR:133) vs. 211 (IQR:133; p = 0.332. The study showed no difference in the therapeutic effect of two clopidogrel formulations (Egitromb and Plavix).
    Platelets 02/2014; · 2.24 Impact Factor
  • Kardiologia polska 01/2014; 72(4):387. · 0.54 Impact Factor
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    ABSTRACT: Antiplatelet drugs play a crucial role in the treatment of patients with myocardial infarction, particularly in association with percutaneous coronary intervention. Their main advantage is the reduction of adverse ischemic incidents and the major disadvantage is the increase in the frequency of hemorrhages. Thus, the choice of appropriate drug depends on the right risk assessment of the development of these complications in individual patients. The aim of this article is to provide an update of antiplatelet therapy in emergency myocardial infarction treatment. Currently, the most important role in the process of platelet inhibition is played by ADP P2Y12 blockers: clopidogrel, prasugrel and ticagrelor. Clopidogrel and prasugrel belong to thienopyridines, and ticagrelor, a drug of irreversible action, is an analogue of adenosine triphosphate. By 2011 clopidogrel, alongside aspirin, had the highest recommendations of world cardiology associations for acute coronary syndrome treatment. The position on clopidogrel was changed following the publication of European Society of Cardiology guidelines for STEMI in 2012 which advocate the administration of acetylsalicylic acid (ASA) and ADP receptor blocker (in combination with ASA). It needs to be stressed that prasugrel and ticagrelor received class IB recommendation, while clopidogrel received only IC. However, the most recent studies aimed at introducing a new generation of antiplatelet drugs of high efficacy in prevention of ischemic incidents and of reversible action: cangrelor and elinogrel, which raise hopes for better prognosis for myocardial infarction patients.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 01/2014; 10(1):32-39. · 0.16 Impact Factor
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    ABSTRACT: Background Sildenafil, a phosphodiesterase-5 inhibitor, has been shown to decrease pulmonary vascular resistance (PVR) in patients with heart failure. The purpose of the study was to evaluate the effect of sildenafil on clinical status and pulmonary vascular reactivity in patients with congestive heart failure. Material and Methods We enrolled 20 patients (18 men and 2 women, mean age 51±12 years, diagnosed with congestive heart failure and pulmonary hypertension. This was a prospective, single-center study. Patients were treated with sildenafil 25 mg TDS for 12 months. Protocol included NYHA evaluation and repeated echocardiography, cardiac pulmonary stress tests, and right- sided catheterization. Results Initially, there were 16 (80%) patients in III NYHA status and 4 (20%) patients in II NYHA. After 12 months, 8 patients were in NYHA III (40%) status and 12 patients in NYHA II (60%). Peak oxygen consumption increased from 12±3 ml/kg/min to 19±4 ml/kg/min after 1-year therapy (p<0.001). The cardiac index increased from 3.1±0.6 L/min/m2 to 3.6±0.4 L/min/m2 (p<0.05). Pulmonary vasculature resistance decreased after 1-year therapy (4.7±1 vs. 1.6±0.5 Woods units (p<0.005) comparing to initials. Mean pulmonary artery pressure decreased to 23±6 mmHg from 42±5 mmHg (p<0.001) after 1-year therapy. Conclusions One-year sildenafil therapy effectively improved clinical status and pulmonary vascular resistance in patients diagnosed with congestive heart failure.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2014; 19:325-30. · 0.82 Impact Factor
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    ABSTRACT: Background Diagnosis of rejection is a major objective in the management of heart transplant recipients. It has been reported that one-third of protocol biopsies in asymptomatic, biochemically stable organ transplant recipients in the first 6 months show unsuspected subclinical graft rejection. Case Report We present the case of a 43-year-old man suffering from dilated cardiomyopathy who underwent orthotropic heart transplantation. The patient was admitted for a protocol endomyocardial biopsy and magnetic resonance imaging (MRI) on the 4th postoperative month as a protocol procedure. The examination revealed clinical status NYHA I with no signs of fatigue, diminution of exercise tolerance, or shortness of breath. His body temperature was not raised. He was referred for endomyocardial biopsy and cardiovascular magnetic resonance (CMR) imaging. CMR imaging showed good left and right ventricle function and contractility. T2 imaging revealed increased signal in the area of the right ventricular free wall, seen both in 4-chamber and short axis views. The patient underwent an endomyocardial biopsy, which demonstrated diffuse infiltrate with multifocal miocyte damage and cellular edema recognized as acute rejection (3a ISHLT grade). Consequently, he was treated with parenteral methylprednisolone administration. The CMR study performed after 1 week of therapy showed that the signal intensity of the edematous areas was significantly decreased. Repetitive endomyocardial biopsy revealed no signs of rejection. Conclusions CMR can be helpful in graft monitoring following heart transplantation. It gives a whole-heart perspective that can be competitive with and/or complementary to endomyocardial biopsy. As a noninvasive study it can be applied more often and facilitates diagnosis of asymptomatic rejection episodes.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2014; 19:447-51. · 0.82 Impact Factor
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    ABSTRACT: Sudden cardiac death mostly resulting from ventricular arrhythmia remains a cause of mortality in 19-30% of adults with congenital heart defects. Indications for implantable cardioverter-defibrillators in primary prophylaxis are still under research. Microvolt T wave alternans (MTWA) is one of the sudden cardiac death risk stratification methods. We determined the incidence of MTWA in these patients and its coincidence with ventricular arrhythmia as well as risk factors of ventricular arrhythmia/sudden cardiac death. 204 patients with complex congenital heart anomalies and 45 healthy volunteers underwent ambulatory ecg monitoring, a cardiopulmonary test, BNP assessment, echocardiography and an MTWA test. After excluding technically inadequate traces, the remaining 179 patients and 43 controls were classified into MTWA positive(+), negative(-) and indeterminate(ind) subgroups. Additionally, MTWA(+) and MTWA(ind) formed an 'abnormal' group, labeled. MTWA(non-). Results. Abnormal MTWA was observed more frequently in the study group compared to controls (59(33.0%)vs1(2.3%), p=0.000001). The MTWA(non-) group compared to MTWA(-) presented a higher number of males (61.0%vs37.5%, p=0.005), predominance of patients with NYHA>I (44.1%vs25.0%, p=0.007), pulmonary hypertension (16.9%vs0.8%, p=0.00007), lower blood saturation (97%(73-100)vs99%(69-100), p=0.0003), higher incidence of malignant arrhythmia (9(15.2%)vs(3(2.5%), p=0.003), lower peak oxygen consumption VO2(ml/kg/min) (23.1±5.9vs26.3±6.7, p=0.002), higher VE/VCO2slope (36.0(25-74)vs31.0(21-58), p=0.01). Multivariate logistic regression analysis proved that pulmonary hypertension (OR=13.7, p=0.03), male gender (OR=10.4, p=0.00002), VE/VCO2slope (OR=1.07, p=0.045) and VO2 (OR=0.89, p=0.04) increase the probability of MTWA(non-). Abnormal MTWA is more frequent in adults with congenital heart diseases than in the healthy population. Its probability increases in patients demonstrating clinical findings conducive to lethal arrhythmia like heart failure and pulmonary hypertension.
    Cardiology journal 10/2013; · 1.15 Impact Factor
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    ABSTRACT: Studies on the treatment of patients with an acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) showed a high rate of aborted MI despite a relatively long delay from the onset of symptoms to reperfusion. To assess predictors of aborted MI in patients undergoing primary PCI. 310 STEMI patients referred for primary PCI within 12 hours of symptom onset were included into a prospective study. Relationships between incidence of aborted MI, clinical, electrocardiographic and angiographic factors were analyzed. Aborted MI was diagnosed in 29 patients (9.8%). Patients with aborted MI did not differ with respect to age (59.4±10.1 vs. 60.5±11.2 years; p=0.88), male sex (75.9% vs. 76.0%; p=0.83), hypertension (51.7% vs. 48.3%; p=0.87) or total ischemic time (215.9±104.6 vs. 241.9±134.3min; p=0.44) except for the frequency of diabetes mellitus (34.5% vs. 16.1%; p=0.02) when compared to group with true MI. TIMI flow ≥2 prior to PCI (86.2% vs. 27.7%; p<0.001), total ST-segment resolution (STSR), both pre-angiography (65.5% vs. 19.5%; p<0.001) and post-PCI (89.7% vs. 69.2%; p=0.018) and myocardial blush grade 3 (89.7% vs. 60.0%; p=0.001) were significantly more frequent in patients with aborted MI. A logistic regression model confirmed TIMI flow≥ 2 prior to PCI (OR 10.7 CI 3.1-37.8; p=0.0002), pre-angiography total STSR (OR 3.6 CI 1.2-10.5; p=0.02) and a history of previous diabetes mellitus (OR 8.6 CI 2.6-27.6; p=0.0003) as predictors of aborted MI. 1. Aborted MI was observed in 9.8% of STEMI patients undergoing PCI. 2. TIMI flow ≥2 and total STSR prior to PCI were identified as major angiographic and electrocardiographic predictors of aborted MI.
    Kardiologia polska 10/2013; · 0.54 Impact Factor
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    ABSTRACT: Recent studies, performed with the use of a commercially available diffusion weighted imaging (DWI) sequence, showed that they are sensitive to the increase of water content in the myocardium and may be used as an alternative to the standard T2-weighted sequences. The aim of this study was to compare two methods of myocardial edema imaging: DWI and T2-TIRM. The study included 91 acute and post STEMI patients. We applied a qualitative and quantitative image analysis. The qualitative analysis consisted of evaluation of the quality of blood suppression, presence of artifacts and occurrence of high signal (edema) areas. On the basis of edema detection in AMI and control (post STEMI) group, the sensitivity and specificity of TIRM and DWI were determined. Two contrast to noise ratios (CNR) were calculated: CNR1 - the contrast between edema and healthy myocardium and CNR2 - the contrast between edema and intraventricular blood pool. The area of edema was measured for both TIRM and DWI sequences and compared with the infarct size in LGE images. Edema occurred more frequently in the DWI sequence. A major difference was observed in the inferior wall, where an edema-high signal was observed in 46% in T2-TIRM, whereas in the DWI sequence in 85%. An analysis of the image quality parameters showed that the use of DWI sequence allows complete blood signal suppression in the left ventricular cavity and reduces the occurrence of motion artifacts. However, it is connected with a higher incidence of magnetic susceptibility artifacts and image distortion. An analysis of the CNRs showed that CNR1 in T2-TIRM sequence depends on the infarct location and has the lowest value for the inferior wall. The area of edema measured on DWI images was significantly larger than in T2-TIRM. DWI is a new technique for edema detection in patients with acute myocardial infarction which may be recommended for the diagnosis of acute injuries, especially in patients with slow-flow artifacts in TIRM images.
    Journal of Cardiovascular Magnetic Resonance 10/2013; 15(1):90. · 4.44 Impact Factor
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    ABSTRACT: The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)].Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m&sup2;, 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m&sup2;, 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
    European Heart Journal 09/2013; · 14.10 Impact Factor
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    ABSTRACT: The aim of our study was to determine the influence of diabetes (DM) on myocardial reperfusion and left ventricular (LV) remodeling in patients with an acute myocardial infarction undergoing primary percutaneous coronary intervention. The study population consisted of 218 patients with first anterior ST-segment elevation myocardial infarction (STEMI) successfully treated with primary coronary angioplasty. We evaluated microvascular reperfusion with the angiographic (myocardial blush grade) as well as electrocardiographic methods (ST-segment resolution >70%). Left ventricular remodelling was defined as an increase in end-diastolic volume ≥ 20%, based on repeated measurements in individual patients. The study population was divided into 2 groups according to the presence n=43 (20%) or absence n=175 (80%) of DM. Patients with DM showed a significantly higher rate of MBG≤2 (45.7% vs. 62.8%, p=0.04) and lower incidence of ST-segment resolution >70% (48% vs. 18.6%, p=0.0003) when compared to non-diabetics. Despite similar incidence of LV remodeling in DM and NDM groups(30.2% vs. 22.4%, p=0.27), echocardiographic features of diastolic impairment and overt symptoms of heart failure were significantly more frequent in diabetic patients (55.2% vs. 27.1%, p=0.006 and 36.1% vs. 18.3%, p=0.02, respectively) at 6-month follow-up. Despite worse microvascular reperfusion in STEMI patients with diabetes the incidence of LV remodeling was similar in comparison to non-diabetic patients. DM was associated with the development of diastolic heart failure.
    Kardiologia polska 08/2013; · 0.54 Impact Factor
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    ABSTRACT: The results of PCI for saphenous vein graft disease, are limited by distal embolization and no-reflow which occurred in 10 to up to 43% of cases (1-5). The aim of the study was to examine the role of new protocol of adenosine administration during PCI in saphenous vein grafts on immediate angiographic results and clinical course. A prospective, single-center, randomized placebo-controlled pilot trial in 32 consecutive patients after CABG (71±12 years, 22 male) with stable and unstable angina (CCS II-IV), who were admitted to our hospital, for saphenous vein graft PCI, was conducted. Patients were randomized to 2 groups. Group A (n=16 patients) received two times adenosine (2mg + 2mg) to the saphenous vein graft during PCI procedure and Group B (n=16 patients) received placebo. No reflow was observed in 1 patients (6.25%) in adenosine group and 6 patients (37.5%) in placebo group (p=0.0325). TIMI 3 flow (94% vs 63%; p=0.0322) and corrected TIMI frame count < 28 (94% vs 63%; p=0.0322) at the end of procedure were better in patients who received adenosine. Myocardial blush grade 2 and 3 at the end of procedure was observed in 15 patients in adenosine group and 10 patients in placebo group (p=0.083). A trend toward lower rate of myocardial infractions in adenosine group was observed (6% vs 25%; p=0.144). Adenosine injections may be effective in preventing no-reflow in the setting of PCI of saphenous vein graphs. Adenosine administration seemed to be associated with more favorable clinical course.
    Kardiologia polska 08/2013; · 0.54 Impact Factor
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    ABSTRACT: Background The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. Methods We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction . We contacted the principal investigator for each participating trial to provide summary data with regard to different prespecified subgroups (age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct related artery, left ventricular (LV) end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number) and 3 different endpoints (change in LVEF, LVEDVI and LV end-systolic volume index (ESVI)). Results Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC treated patients compared to controls: (2.55% increase, 95% Confidence Interval (CI) 1.83 to 3.26, p<0.001). Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI -4.86 to -1.47, p<0.001; -2.60 mL/m², 95% CI 3.84 to -1.35, p<0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI 2.36 to 4.39) compared to older patients (age ≥55 years, 1.77%, 95% CI 0.80 to 2.74, p=0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF<40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI 4.27 to 6.33 in patients with LVEF <40% compared to 1.45%, 95% CI 0.60 to 2.31 in LVEF ≥40%, p<0.001. No clear interaction was observed between other subgroups and outcomes.
    European Heart Journal 08/2013; · 14.10 Impact Factor
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    ABSTRACT: BACKGROUND: Among adults with congenital heart diseases (CHD) evaluation of sudden cardiac death (SCD) risk remains a great challenge. Although microvolt T-wave alternans has been incorporated into SCD risk stratification algorithm, its role in adults with CHD still requires investigation. We sought to determine the incidence of MTWA in this specific group and its coincidence with ventricular arrhythmia (VA) and other clinical findings presumably associated with SCD. METHODS: A case--control study was performed in which 102 patients with CHD characterized by right ventricle pathology or single ventricle physiology (TGA, UVH, Ebstein's anomaly, ccTGA, Eisenmenger syndrome, DORV, CAT, unoperated ToF) were compared to 45 age- and sex-matched controls. All subjects underwent spectral MTWA test, ambulatory ecg monitoring, cardiopulmonary test, BNP assessment. After excluding technically inadequate traces, the remaining MTWA results were classified as positive(+), negative(-) and indeterminate(ind). Due to similar prognostic significance MTWA(+) and (ind) were combined into a common group labeled 'abnormal'. RESULTS: Abnormal MTWA was present more often in the study group, compared to controls (39.2% vs 2.3%, p = 0.00001). Sustained ventricular tachycardia (sVT) was observed more often among subjects with abnormal MTWA compared to MTWA(-): 19.4% vs 3.6%, p = 0.026. The patients with abnormal MTWA had a lower blood saturation (p = 0.047), more often were males (p = 0.031), had higher NYHA class (p = 0.04), worse cardiopulmonary parameters: %PeakVO2 (p = 0.034), %HRmax (p = 0.003). Factors proven to increase probability of abnormal MTWA on multivariate linear regression analysis were: sVT (OR = 20.7, p = 0.037) and male gender (OR = 15.9, p = 0.001); on univariate analysis: male gender (OR = 2.7, p = 0.021), presence of VA (OR = 2.6, p = 0.049), NYHA > I (OR = 2.06, p = 0.033), %HRmax (OR = 0.94, p = 0.005), %PeakVO2 (OR = 0.97, p = 0.042), VE/VCO2slope (OR = 1.05, p = 0.037). CONCLUSIONS: Abnormal MTWA occurs significantly more often in adults with the chosen forms of CHD than among healthy subjects. The probability of abnormal MTWA increases in patients with malignant VA, in males and among subjects with heart failure and cyanosis. MTWA might be of potential role in risk stratification for SCD in adults with CHD.
    BMC Cardiovascular Disorders 04/2013; 13(1):26. · 1.46 Impact Factor
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    ABSTRACT: Objectives: The aim of this single-center, randomized placebo-controlled trial in 70 consecutive patients (64 ± 14 years) with acute myocardial infarction was to examine the role of a new protocol of adenosine administration during primary angioplasty on immediate electrocardiographic and angiographic results, clinical outcome and 1-year follow-up. Methods: Group A (n = 35) twice received intracoronary adenosine through the guiding catheter: immediately after crossing the lesion of the infarct-related artery with guidewire and then after first balloon inflation. Group B (n = 35) received placebo. Results: Resolution of ST segment elevation was more frequently observed in the adenosine than in the placebo group (p < 0.01). Percutaneous coronary intervention (PCI) resulted in borderline better TIMI 3 flow after the procedure in the adenosine group than in the placebo group. Myocardial blush grade 3 at the end of the procedure was significantly improved in the adenosine compared to the placebo group (p < 0.05). At 1-year the composite end-point of death, recurrent myocardial infarction, heart failure and clinically driven target vessel revascularization was present in 8 patients in the adenosine group and 16 patients in placebo group (p < 0.05). Conclusions: Intracoronary adenosine improved electrocardiographic and angiographic results in patients undergoing primary PCI and seemed to be associated with more favorable clinical course.
    Cardiology 03/2013; 124(3):199-206. · 1.52 Impact Factor
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    ABSTRACT: Background It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI). Methods Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients ≥75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital. Emergency coronary angiography was performed if fibrinolysis failed; otherwise, angiography was performed 6 to 24 hours after randomization. The primary end point was a composite of death, shock, congestive heart failure, or reinfarction up to 30 days. Results The primary end point occurred in 116 of 939 patients (12.4%) in the fibrinolysis group and in 135 of 943 patients (14.3%) in the primary PCI group (relative risk in the fibrinolysis group, 0.86; 95% confidence interval, 0.68 to 1.09; P=0.21). Emergency angiography was required in 36.3% of patients in the fibrinolysis group, whereas the remainder of patients underwent angiography at a median of 17 hours after randomization. More intracranial hemorrhages occurred in the fibrinolysis group than in the primary PCI group (1.0% vs. 0.2%, P=0.04; after protocol amendment, 0.5% vs. 0.3%, P=0.45). The rates of nonintracranial bleeding were similar in the two groups. Conclusion Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623 .).
    New England Journal of Medicine 03/2013; · 51.66 Impact Factor
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    ABSTRACT: We present a case of a 21-year-old man after Senning operation admitted to our hospital for transvenous implantation of a dual chamber pacemaker. The presence of persistent left superior vena cava enabled us to implant the desired dual chamber pacemaker. It is an extremely unusual situation when two pacemaker leads utilise two different routes to the heart: superior caval vein - atrial baffle - ventricle and persistent left superior caval vein - atrium.
    Kardiologia polska 01/2013; 71(1):102-3. · 0.54 Impact Factor

Publication Stats

401 Citations
345.05 Total Impact Points

Institutions

  • 1995–2014
    • Poznan University of Medical Sciences
      • • Department of Cardiology
      • • Department of Pathophysiology
      • • Clinic of of Cardiology I
      Posen, Greater Poland Voivodeship, Poland
  • 2009–2013
    • Uniwersytet Medyczny im.Karola Marcinkowskiego w Poznaniu
      Posen, Greater Poland Voivodeship, Poland