[Show abstract][Hide abstract] ABSTRACT: Severe heart failure can be a rare symptom of hypocalcemia. We report a case of a 58 year-old male admitted with a diagnosisof acute coronary syndrome. The ECG showed prolonged QTc interval with severly impared left ventricular ejection fractionrecognised in echocardiography. During the hospitalisation hypocalcemia due to primary hypoparathyreoidism was revealedto be the cause of those symptoms.
Kardiologia polska 01/2013; 71(6):606-608. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Simultaneous thrombosis of multiple epicardial coronary arteries is an uncommon clinical finding in ST-segment elevation myocardial infarction (STEMI). We describe a 44 year-old male present with STEMI who was found to have simultaneously occluded two epicardial arteries. There is many clinical states that can lead to multiple thrombosis i.e. essential trombocytosis, hiperhomocysteinaemia, depletion of antitrombin III, cocaine abuse etc. In this particular case L-arginin supplementation and association with thrombosis or atherosclerosis progression is discussed.
Kardiologia polska 01/2013; 71(3):279-82. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present the case of a 55 year-old male admitted to Malopolskie Centrum Sercowo-Naczyniowe PAKS in Chrzanów with diagnosis of anterior wall myocardial infarction (STEMI). We decided to treat the patient invasively because of presence of chest pain, persistent ST elevation and signs of haemodinamical instability. As it revealed later patient needed combination of PCI of left main/left anterior descending artery with PTA of iliac artery.
Kardiologia polska 01/2012; 70(1):92-4; discussion 95. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although durable polymer coated drug-eluting stents (DES) are standard care in percutaneous coronary interventions, new stent platforms employing biodegradable polymer based drug delivery are increasingly being used in clinical practice.
To evaluate the short- (28 days) and medium-term (90 days) vascular effects of the new biodegradable polymer coated sirolimus-eluting stent - the PROLIM stent.
The objectives of the study were evaluated using standard angiographic and histological methods. In addition, the mechanical integrity of tested stents was assessed using Faxitron imaging. A total of 12 PROLIM stents, 11 biodegradable polymer only coated stents (BPCS), and 12 bare metal stents (BMS) were implanted in the coronary arteries of 16 female non-atheroslerotic domestic swine using an overstretch of 1.1:1.0.
At 28 days, neointimal proliferation was significantly lower in the PROLIM and BMS stents compared to the BPCS stents (p ≤ 0.05). Interestingly, despite thin neointima found at this time in the PROLIM group, there was a further significant decrease in neointimal formation between 28 and 90 days (p = 0.04). Although a statistically bigger neointima was found in BPCS stents at 28 days compared to the PROLIM and BMS stents, there was a 50% decrease in the neointimal area at 90 days follow-up (p = 0.02) which reached the level seen in other groups. The endothelialisation was completed in all tested stents after 28 days. There was a significant increase of fibrin depositions in the PROLIM treated arteries at 28 days which were resorbed nearly completely at 90 days follow-up. At 28 days, the inflammatory response was found to be numerically higher in the BPCS stents (p = NS) compared to other tested groups. On the contrary, at 90 days follow-up when the degradation process of the polymer had been completed, the inflammatory reaction decreased substantially to the level seen in the PROLIM and BMS stents. Faxitron analysis of the stented arteries revealed no major abnormalities except for isolated strut fractures observed in the mid portions of two BMS stents and one BPCS stent.
The PROLIM - a biodegradable polymer coated sirolimus-eluting stent - demonstrates very good short-term and medium-term angiographic and histological results. The lack of 'catch-up phenomenon', fast endothelialisation process, and minimal inflammatory reaction may contribute to favourable clinical outcomes using PROLIM stents.
Kardiologia polska 01/2012; 70(7):703-11. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Backgroud: Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM). Aim: To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group. Methods: 71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM. Results: The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02). Conclusions: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.
Kardiologia polska 01/2012; 70(12):1215-24. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 91 Successful recanalization of total chronic occlusion of the superficial femoral artery by antegrade subintimal angioplasty with stenting using the Pioneer Plus Re-Entry Catheter Udana rekanalizacja przewlekłej całkowitej okluzji tętnicy udowej powierzchownej poprzez angioplastykę subintimalną ze stentowaniem przy użyciu cewnika Pioneer Plus Re-Entry A b s t r a c t The subintimal angioplasty is one of the most frequent techniques used for total chronic occlusion (CTO) treatment. Nevertheless, this approach is limited by the lack of controlled re-entry into the true lumen of the target vessel. We present a case of a 85-year-old man with symptomatic CTO of the left superficial femoral artery (SFA). After initially unsuccessful subintimal recanalization with Confianza wire, Pioneer Plus Catheter with Intravascular Ultrasound Volcano system guidance were used for a true lumen re-entry. Finally lesion was treated with angioplasty and stents. Procedure was successful without complications, no residual stenosis was noted. The patient was discharged home four hours after procedure. The one day and three weeks follow up showed no vascular complications and the patient had no residual symptoms. The ankle-brachial index of the left extremity has improved from baseline 0.22 to 0.98. Key words: re-entry catheter, subintimal angioplasty, total chronic occlusion (CTO), superficial femoral artery (SFA) S t r e s z c z e n i e Subintimalna angioplastyka jest jedną z najczęściej stosowanych technik podczas leczenia przewlekłych całkowitych okluzji tęt-nic kończyny dolnej (CTO). Metoda ta jest jednak ograniczona brakiem kontroli nad powrotem do prawdziwego światła naczynia. Pre-zentujemy przypadek 85-letniego mężczyzny z objawami CTO w lewej tętnicy udowej powierzchownej (SFA). Po nieudanym począt-ku rekanalizacji subintimalnej prowadnikiem Confianza, cewnik Pioneer Plus z systemem ultrasonografii wewnątrznaczyniowej Volcano został wykorzystany do powrotu do prawdziwego światła naczynia. Ostatecznie do zaopatrzenia zmiany zastosowano angioplasty-kę i stentowanie. Procedura zakończyła się pomyślnie, bez powikłań, nie stwierdzono zwężenia rezydualnego. Mężczyzna został wypi-sany do domu po 4 godz. po zabiegu. W trakcie jednodniowej i 3-tygodniowej obserwacji nie stwierdzono powikłań naczyniowych, a pacjent nie zgłaszał pozostałych objawów. Wskaźnik kostkowo-ramienny lewej kończyny poprawił się z wartości wyjściowej 0,22 do 0,98. W niniejszym artykule przedstawiono cewnik Pionieer Plus z systemem ultrasonografii wewnątrznaczyniowej, którym uzyskano światło prawdziwe tętnicy udowej powierzchownej (SFA), a następnie przeprowadzono angioplastykę ze stentem, uzyskując dobry efekt angiograficzny oraz kliniczny. Słowa kluczowe: cewnik re-entry, angioplastyka subintimalna, przewlekła całkowita okluzja tętnic kończyny dolnej, tętnica udowa powierzchowna
Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 07/2011; 7(1):91-94. · 0.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Coronary artery aneurysm is a rare congenital or acquired anomaly. The commonest location of coronary artery aneurysms is the right coronary artery and they are found slightly more often in males. We report an unusual case of multiple and extremely large aneurysms, therefore potentially at risk of rupture or thrombosis.
[Show abstract][Hide abstract] ABSTRACT: Biodegradable polymer-coated stents may have positive effects on arterial healing, and reduce the need for prolonged antiplatelet therapy.
To assess the vascular effects of the biodegradable polymer proposed as a stent coating, as well as to evaluate inhibition of intimal hyperplasia by Biodegradable Polymer-Coated Paclitaxel-Eluting Stents (BP-PES, LUC-Chopin, Balton) in porcine coronary arteries.
A total of 19 stents were implanted into the coronary arteries of 13 pigs: seven bare metal stents (BMS), six biodegradable polymer-coated stents (PCS) and six BP-PES. Animals were followed up for 28 days. Additionally, 11 BP-PES were implanted in four pigs which were followed for 90 days. Twenty eight and 90 days after stent implantation, the control coronary angiography was performed. Subsequently, the animals were sacrificed, their hearts were extracted and the coronary arteries were isolated for further histopathological analysis.
After 28 days, BP-PES stents effectively limited neointimal hyperplasia in comparison to the control group (LL = 0.48 +/- 0.06 for BMS vs 0.87 +/- 0.16 for PCS vs 0.15 +/- 0.05 mm for BP-PES; p < 0.05). However, at three months, a 'catch-up' effect in neointimal formation was observed. Histopathology demonstrated favourable safety, with complete endothelialisation and inflammation significantly decreased between one and three months.
It seems that the biodegradable polymer-coated, paclitaxel-eluting stent examined in the present study is both safe and feasible. This supports the first such study in humans being conducted.
Kardiologia polska 05/2010; 68(5):503-9. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of subacute occlusion of the left subclavian artery (LSA) manifesting as acute coronary syndrome and associated with coronary-subclavian steal syndrome (CSSS) in a 56-year-old man following coronary artery bypass grafting (CABG) is presented. Complex percutaneous angioplasty with stenting of the LSA and left vertebral artery were successfully performed. In this article, the clinical management of unstable post-CABG patients with occlusion of the subclavian artery is discussed.
Kardiologia polska 02/2010; 68(2):226-9; discussion 230-1. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78+/-4.8 years with high operation risk and Logistic EuroSCORE 25+/-7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%)--via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one--two months after the implantation). During the mean follow-up of 5+/-1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.
Kardiologia polska 08/2009; 67(8):936-40. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In-stent restenosis (ISR) is one of the major limitations of percutaneous coronary intervention (PCI).
To evaluate the relationship between the levels of hs-CRP, IL-6, IL-10 and intimal hyperplasia six months after coronary bare metal stent (BMS) implantation.
The study population consisted of 73 consecutive patients who underwent bare metal stent implantation into narrowed coronary segments. A total of 74 stents were implanted. Angiographic study after six months, together with evaluation of serum level of IL-6 (pg/ml), IL-10 (pg/ml), hs-CRP (microg/ml), fasting insulin (microIU/ml) and glucose (mg%) was performed. Insulin sensitivity was calculated using the HOMA-IR formula. The QCA analysis of stented segments was performed at baseline, after intervention and at six-month follow-up.
Restenosis at six months occurred in 10 patients (13.7%). The mean % diameter stenosis at follow-up was 27.8 +/- 19% and late loss was 0.81 +/- 0.6 mm. We found a correlation between late loss and serum hs-CRP, IL-6 and IL-10 concentration. There was no correlation between the lipid profiles, insulin levels and HOMA-IR and re-narrowing of the stented segments. Patients with restenosis were characterised by significantly higher serum concentration of CRP (2.04 +/- 3.4 vs. 10.38 +/- 6.7 microg/ml, p = 0.0036), IL-6 (14.98 +/- 8.3 vs. 5.70 +/- 5.5 pg/ml, p = 00062), and fasting glucose (184.0 +/- 50.5 vs. 107.5 +/- 40.4 mg%, p = 0.0051), as well as lower IL-10 levels (1.25 +/- 0.6 vs. 4.85 +/- 4.9 pg/ml, p = 0.0000). The ROC analysis indicated that CRP (> 2.86 microg/ml), IL-6 (> 6.24 pg/ml) and IL-10 (< 1.7 pg/ml) values predicted the restenosis with reasonable accuracy. A multiple logistic regression model identified CRP and IL-10 levels as independent predictors of restenosis.
We demonstrated that elevated inflammatory markers 6 months after PCI are associated with late angiographic in-stent restenosis.
Kardiologia polska 07/2009; 67(6):623-30. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of a 72-year-old man with anterior wall myocardial infarction and PCI procedure complicated by coronary artery perforation, is presented. Life-threatening complication was successfully treated percutaneously with graft-stent implantation, and the patient was discharged home five days later in a good condition. Control coronary angiography after 3 months was scheduled.
Kardiologia polska 05/2009; 67(4):446-8; discussion 449-50. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 51-year-old female two years after CABG presented with unstable angina and inferior wall ischaemia. Coronary angiography revealed occluded graft to RCA and chronic total occlusion of RCA with good collateral flow from distal LAD to RCA. The CTO was successfully crossed and dilated through epicardial collaterals from distal LAD (retrograde approach). Finally, antegrade angioplasty with two stents implantation was performed achieving TIMI 3 flow.
Kardiologia polska 04/2009; 67(3):326-9; discussion 330. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study sought to assess of the mobilization of nonhematopoietic very small embryonic-like stem cells (VSELs) in acute myocardial infarction (MI).
Acute MI induces mobilization of bone marrow stem cells. Recently, a rare population of VSELs, expressing markers of embryonic pluripotent stem cells (PSCs), was identified in adult murine bone marrow and human umbilical cord blood.
Thirty-one patients with acute MI and 30 healthy subjects were enrolled. Blood was sampled on admission, after 24 h, and 5 days later. Erythrocytes were lysed and lin(-)CD45(-) VSELs were isolated using a live cell sorting system (FACSAria, Beckton Dickinson, San Jose, California).
In healthy subjects the median number of circulating VSELs was very low (median 0.8 [range 0 to 1.3]) cells/microl. In acute MI, VSELs were mobilized early (median 2.7 [range 0.2 to 3.9] cells/microl; p < 0.001) and remained elevated after 24 h and 5 days (median 4.7 [range 0.2 to 6.4] cells/microl; p < 0.003, and median 2.6 [range 0.3 to 3.6] cells/microl; p < 0.03, respectively). The mobilization of VSEL was significantly reduced in patients older than 50 years and with diabetes in comparison with younger and nondiabetic patients. Circulating VSELs were small (7 to 8 microm) and enriched in the messenger ribonucleic acid of PSC markers (Oct-4, Nanog), cardiac lineage (GATA-4, Nkx2.5/Csx, MEF2C), and endothelial (VE-cadherin) markers. The presence of PSC markers (Oct-4, SSEA-4) and the chemokine receptor CXCR4 in circulating VSELs was confirmed at the protein level by immunofluorescent staining and ImageStream system (Amnis Corporation, Seattle, Washington) analysis.
Acute MI induced mobilization of VSELs expressing pluripotent markers, early cardiac and endothelial markers, and chemokine receptor CXCR4.
Journal of the American College of Cardiology 02/2009; 53(1):1-9. · 14.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Comparison of intracoronary infusion of bone marrow (BM)-derived unselected mononuclear cells (UNSEL) and selected CD34(+)CXCR4(+) cells (SEL) in patients with acute myocardial infarction (AMI) and reduced <40% left ventricular ejection fraction (LVEF).
Two hundred patients were randomized to intracoronary infusion of UNSEL (n = 80) or SEL (n = 80) BM cells or to the control (CTRL) group without BM cell treatment. Primary endpoint: change of LVEF and volumes measured by magnetic resonance imaging before and 6 months after the procedure. After 6 months, LVEF increased by 3% (P = 0.01) in patients treated with UNSEL, 3% in patients receiving SEL (P = 0.04) and remained unchanged in CTRL group (P = 0.73). There were no significant differences in absolute changes of LVEF between the groups. Absolute changes of left ventricular end-systolic volume and left ventricular end-diastolic volume were not significantly different in all groups. Significant increase of LVEF was observed only in patients treated with BM cells who had baseline LVEF < median (37%). Baseline LVEF < median and time from the onset of symptoms to primary percutaneous coronary intervention > or = median were predictors of LVEF improvement in patients receiving BM cells. There were no differences in major cardiovascular event (death, re-infarction, stroke, target vessel revascularization) between groups.
In patients with AMI and impaired LVEF, treatment with BM cells does not lead to a significant improvement of LVEF or volumes. There was however a trend in favour of cell therapy in patients with most severely impaired LVEF and longer delay between the symptoms and revascularization.
European Heart Journal 02/2009; 30(11):1313-21. · 14.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The congenital coronary fistula is a rare anomaly revealed sometimes during diagnostic procedures. Although it is rarely symptomatic many authors consider elective procedure of closure, because of relatively low risk of procedure. This case demonstrate the percutaneous closure of a congenital coronary artery fistula using graftstent.
Kardiologia polska 01/2009; 66(12):1342-4. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bicuspid aortic valve is one of the most common congenital cardiac anomalies and it may be accompanied by other cardiovascular anomalies. Sinus of Valsalva aneurysm is a rare anomaly in adult population, but it coexists with bicuspid aortic valve quite often. This report describes a 57 years-old patient who had a bicuspid aortic valve accompanied by unruptured Valsalva sinus aneurysm with significant left anterior narrowing and who underwent successful surgery with ascending aorta and aortic valve replacement as well as coronary by-pass grafting.
[Show abstract][Hide abstract] ABSTRACT: Efficacy of carotid endarterectomy (CEA) in prevention of stroke in patients with carotid artery stenosis has been confirmed in randomised trials. Carotid artery stenting (CAS) is a routine clinical practice and recent results of CAS are not worse than CEA. Moreover, percutaneous transluminal angioplasty (PTA) techniques allow other cephalad arteries to be dilated.
To assess early and long-term outcome of PTA of cephalad arteries and to determine risk factors of early and late major adverse cardiovascular and cerebral events (MACCE).
The study group consisted of 223 consecutive patients (151 males, 67.7%, mean age 65.3+/-8.6) in whom 256 PTA procedures of cephalad arteries were performed. Two hundred and forty-two internal carotid, 7 common carotid and 15 vertebral arteries were dilated. Thirty-four patients underwent one-stage carotid and coronary procedures, while in 46 patients one-stage carotid and peripheral procedures were performed. Neuroprotection with a distal protection device was used in 51.5% of cases. The procedures were divided into two groups: with high (n=181) and low (n=75) risk of cardiovascular events. Early and late events were recorded and analysed subsequently.
In hospital 30-day MACCE occurred in 12 (4.6%) patients, including 7 (2.7%) strokes, 3 (1.1%) myocardial infarctions and two (0.8%) deaths. Transient ischaemic attacks were observed in 8 patients, pulmonary oedema in 3 cases, as well as a single episode of retinal artery embolisation and acute renal insufficiency. The incidence of 30-day MACCE was not significantly higher in the high-risk group (6.07 vs. 1.33%; NS), but the risk of any adverse event was significantly higher (p=0.03). There was no difference in stroke incidence between procedures with or without neuroprotection (2.27 vs. 3.22%; NS). There was no difference in risk of MACCE between angioplasty of cephalad artery and one-stage cephalad and coronary artery angioplasty procedure (3.6 vs. 5.5%; NS). During 50.3+/-20 months of follow-up there were 16 (7.1%) deaths, 9 (3.5%) strokes and 6 (2.3%) re-stenoses confirmed angiographically. One-year total survival and one-year MACCE-free survival rates according to the Kaplan-Meier analysis were 94.9% and 89.0%, showing a trend towards better outcome in the low-risk group (F-Cox=2.46; p=0.19 and F-Cox=2.17; p=0.09 respectively).
Percutaneous transluminal angioplasty of cephalad arteries is safe and feasible, with a low periprocedural complication rate and good late outcome. Carotid artery stenting is an alternative method to CEA.
Kardiologia polska 04/2008; 66(3):233-42, discussion 243. · 0.54 Impact Factor