[Show abstract][Hide abstract] ABSTRACT: Background: Coronary artery occlusion is not always manifested with ST-elevation and some patients can have patent coronary vessel. Aims: We evaluated circulating microRNA profile to discriminate subjects with infarctrelated artery (IRA) occlusion. Methods and results: Patients (n = 43) with uncomplicated ACS and positive troponins were classified with respect to patent vs. occluded IRA or ST-elevation vs. non-ST elevation MI (STEMI vs. NSTEMI). Expression levels of serum miRNAs (miR-1, -16, -34a, -122, -124, -208b, -133a/b, -375, and -499) were analyzed. Out of 16 STEMI and 27 NSTEMI patients, IRA occlusion was noted in 12 and 15 patients, respectively. The remaining 4 STEMI and 12 NSTEMI patients had patent IRA. STEMI patients had higher troponin T levels and a 3.83-fold higher miR-134 expression (p<0.025). Patients with the occluded vs. patent IRA had higher levels of miR-133a (fold change: 7.00), miR-133b (4.57), miR-34a (5.50), miR-124
(2.55) and miR-134 (3.45), but no difference in troponin T levels. ROC analysis identified decision making miRNAs in occluded vessels: miR-124 (AUC: 0.787, p<0.001), miR-133b (AUC: 0.704; p=0.006) and miR-134 (AUC: 0.686, p=0.016). With respect to STEMI, only miR-134 showed discriminating value (AUC: 0.725, p=0.002). Conclusions: The degree of IRA occlusion determines circulating miRNA expression and specific miRNAs may be useful in indicating patients requiring urgent coronary revascularization.
Kardiologia polska 09/2015; DOI:10.5603/KP.a2015.0174 · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION The results of the ABSORB trial showed the efficacy and safety of bioresorbable vascular scaffolds (BVS) and their unique advantage, namely, the restoration of vasomotion after full biodegradation. OBJECTIVES The aim of the registry was to evaluate procedural issues, angiographic results, and clinical outcomes of patients with acute coronary syndrome (ACS) treated with BVS implantation. PATIENTS AND METHODS The study included 100 patients. Cohort 1 comprised 46 patients with unstable angina; cohort 2, 38 patients with non-ST-segment elevation myocardial infarction; and cohort 3, 16 patients with ST-segment elevation myocardial infarction. RESULTS Predilation was performed in 93% of the patients. The final Thrombolysis In Myocardial Infarction (TIMI) 3 flow was achieved in 99% of the patients. In all patients, BVS was successfully implanted. In 81% of the patients, postdilation was performed with a balloon catheter with the same diameter as BVS; in 11%, with a balloon catheter with a diameter of 0.25 mm larger than BVS; and in 7%, with a balloon catheter with a diameter of 0.5 mm larger than BVS. We observed no no-reflow phenomenon, 1 distal embolization, and 2 slow-flow phenomena. Two major adverse cardiac events were reported, namely, periprocedural myocardial infarction in 2 patients. During 1-year follow-up, we observed only 1 additional myocardial infarction caused by stent thrombosis as well as 1 target lesion revascularization. CONCLUSIONS In our study, BVS in patients with ACS showed to be a safe and effective procedure.
Polskie archiwum medycyny wewnȩtrznej 12/2014; 124(12):669-77. · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The aim of this study was to prospectively perform ambulatory 24-h ECG monitoring to assess the effects of transcatheter closure of atrial septal defect (ASD).
Methods and results:
A total of 235 consecutive subjects (female, n=163; male, n=72; age, 44.6±14.4 years) were enrolled in the study, who were due undergo ASD closure. Holter monitoring was performed before procedure and at 1, 6 and 12 months of follow-up. During the procedure transient supraventricular arrhythmia occurred in 8 patients (3.4%), and bradycardia in 3 (1.3%). In 3 patients (1.3%) an episode of atrial fibrillation occurred in the first hour after the procedure. In 8 patients (3.4%) transient first-degree atrioventricular block was noted. A significant increase in number of supraventricular extrasystoles (SVES)/24 h was noted 1 month after the procedure (P<0.001). On multiple forward stepwise regression analysis, device size and fluoroscopy time had an influence on increase in number of SVES seen 1 month after the procedure (P<0.001).
Transcatheter closure of ASD is associated with a transient increase in supraventricular premature beats and a small risk of conduction abnormalities and paroxysmal atrial fibrillation in early follow-up. Transcatheter closure of ASD does not reduce arrhythmia that appears prior to ASD closure. Larger device size and longer procedure time are associated with increased risk of supraventricular arrhythmia on early follow-up.
[Show abstract][Hide abstract] ABSTRACT: IntroductionClosure of the atrial septal defect in patients with insignificant shunt is controversial.AimTo evaluate the outcomes of transcatheter closure of atrial septal defect (ASD) in symptomatic patients with borderline shunt.Material and methodsOne hundred and sixty patients (120 female, 40 male) with a mean age of 30.1 ±16.2 (20–52) years with a small ASD who underwent transcatheter closure were analyzed. All patients had a small ASD with Qp: Qs ratio ≤ 1.5, mean 1.2 ±0.9 (1.1–1.5) in echo examination. Cardiopulmonary exercise tests, clinical study, transthoracic echocardiographic study as well as quality of life (QoL) (measured using the SF36 questionnaire (SF36q)) were repeated in all patients before and after the procedure.ResultsThe devices were successfully implanted in all patients. After 12 months of ASD closure, all the patients showed a significant improvement of exercise capacity (oxygen consumption – 21.9 ±3.1 vs. 30.4 ±7.7, p > 0.001). The QoL improved in 7 parameters at 12-month follow-up. The mean SF36q scale increased significantly in 141 (88.1%) patients of mean 43.2 ±20.1 (7–69). A significant decrease of the right ventricular area (20.3 ±1.3 cm2 vs. 18.3 ±1.2 cm2, p < 0.001) and the right atrial area (15.2 ±1.9 cm2 vs. 12.0 ±1.6 cm2, p < 0.001) was observed at 12-month follow-up.ConclusionsClosure of ASD in the patients with insignificant shunt resulted in significant durable clinical and hemodynamic improvement after percutaneous treatment.
Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 06/2014; 10(2):78-83. DOI:10.5114/pwki.2014.43510 · 0.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Significant renal artery stenosis (RAS) may lead to left ventricle (LV) hypertrophy and diastolic function (DF) impairment through complex mechanisms: activation of cytokines and/or systolic and diastolic blood pressure (SBP, DBP) increase.
To assess interrelations between LV mass (LVM), DF and cytokines in patients undergoing renal artery stenting (PTA, percutaneous angioplasty of renal artery).
The study group comprised 72 subjects (44.4% men), 64.1 ± 9.9 years with RAS referred to PTA. SBP, DBP, transforming growth factor beta1 (TGF-β1), aldosterone, B-type natriuretic peptide (BNP) levels and change in LVM and LVM index (LVMI) and DF (Evel, e'vel, E/A ratio, E/e' ratio, Artime-Atime) on echocardiography were assessed preprocedurally, and three and 12 months postprocedurally.
TGF-β1 level decreased from 13.3 ± 14.9 to 8.6 ± 8.0 ng/mL (p = 0.027), while BNP increased from 89.1 ± 86.3 to 131 ± 105 pmol/mL (p < 0.001). A significant reduction in LVMI in women (79.4 ± 16.9 vs. 95.7 ± 18.5 g/m², p < 0.001) and men (77.2 ± 16.8 vs. 100.1 ± 19.7 g/m², p < 0.001) was found at 12 months vs. baseline. Degree of LVM reduction correlated with baseline LVM (p < 0.001; r = -0.612) and e'vel (p = 0.05; r = 0.230), but not with BP values. Among DF parameters, only e'vel increased significantly at 12 months (5.54 ± 1.57 vs. 5.92 ± 1.65 cm/s; p = 0.039), while A/E and E/e' ratio, Artime-Atime remained similar (p = 0.457, p = 0.283 and p = 0.258). Factors associated with e'vel increase ≥ 0.3 cm/s at 12 months were baseline LVM < 165 g (p = 0.043, RR = 1.39, CI 1.01-1.46), Evel (p = 0.015, RR = 1.26, CI 1.15-1.52), e'vel (p < 0.001, RR = 1.42, CI 1.18-1.7), DBP decrease > 10 mm Hg (p = 0.055, RR = 1.2, CI 1.0-1.44) and TGF-β1 > 8 ng/mL (p = 0.024, RR = 1.24, CI 1.03-1.49) at 12 months.
Significant LVMI reduction was observed after PTA of RAS, but it was independent of BP reduction. e'vel increase was independently associated with baseline LVM, Evel, e'vel, and 12 month decrease in DBP > 10 mm Hg.
Kardiologia polska 04/2013; 71(2):121-8. DOI:10.5603/KP.2013.0003 · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Incidence of patent foramen ovale (PFO) has been estimated at 25% in the general population and 6% for larger defects. Data on the relationship between PFO morphology and the risk of stroke are limited. PFO closure has become a common practice in many centres, although recent guidelines limit indications for such treatment to patients with cryptogenic (recurrent) stroke. Aim: To investigate whether PFO morphology assessed by transoesophageal echocardiography (TOE) differed between patients with symptoms and those who had an asymptomatic PFO. Methods: We analysed 88 consecutive patients (48 female, 40 male; mean age 36.1 ± 16.2 [range 18-59] years) who underwent TOE before transcatheter PFO closure due to a cryptogenic cerebrovascular event (Group I) and compared them to 88 consecutive patients (49 female, 39 male; mean age 35.7 ± 14.2 [range 18-57] years) with an asymptomatic PFO found incidentally on TOE (Group II). The diagnosis of stroke was based on the occurrence of a new acute focal neurological deficit, with neurological signs and symptoms persisting for 〉 24 h, subsequently confirmed by computed tomography and/or magnetic resonance imaging. Multiplane TOE was conducted as per guidelines using commercially available instruments. The interatrial septum was viewed in the transverse midoesophageal 4-chamber view and the longitudinal biatrial-bicaval view. PFO was diagnosed with intravenous injections of agitated saline while the patient was at rest and during the Valsalva manoeuvre. We analysed PFO size (resting and maximal separation of the septum primum and secundum during the Valsalva manoeuvre), tunnel length (maximal overlap of the septum primum and secundum), presence of an atrial septal aneurysm (excursion 〉 15 mm), shunt severity (mild: 3-5, moderate: 6-25, severe 〉 25 microbubbles) and prominence of the Eustachian valve. Results: The two groups did not differ with respect to age and sex distribution. Group I showed larger PFO size (maximal separation 3.9 ± 1.4 vs. 1.3 ± 1.3 mm, p 〈 0.0001), longer tunnel length (14 ± 6 vs. 12 ± 5.5 mm, p 〈 0.05) and a greater frequency of atrial septal aneurysm (55% vs. 15%, p 〈 0.0001) compared to Group II (controls). Group I was also characterised by a higher proportion of large PFOs (≤ 4 mm; 50% vs. 18%, p 〈 0.001) and severe shunt (40% vs. 2%, p 〈 0.0001). Conclusions: PFO in symptomatic patients is larger in size, has a longer tunnel and is more frequently associated with atrial septal aneurysm. Asymptomatic patients with PFO characteristics similar to that seen in stroke patients require more careful clinical evaluation. It may be debated whether such patients should be recruited to prospective trials to evaluate indications for PFO closure in stroke prevention.
Kardiologia polska 12/2012; 70(12):1258-1263. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Microparticles (MPs) are small vesicles between 100 and 500 nm, released from different cells including blood, endothelium, smooth muscle, and retina cells. MPs are produced during shedding process in response to some stressing and stimulating factors, as well as during apoptosis. The cellular machinery leading to MP shedding involves the loss of the plasma membrane asymmetry and phosphatidylserine externalization with an increase in cytosolic calcium concentrations. MPs not only transfer membrane proteins from the cells of their origin but also convey phospholipids and microRNA to the distant cells. Some of these macromolecules have neoangiogenetic properties (factor XII, tissue factor or mitogen-activated protein kinases) or participate in modulation of vascular senescence or remodeling (miRNAs). AREAS COVERED: The authors summarise recent knowledge about MP biology and pathophysiology. The mechanisms involved in MP release are discussed, and special emphasis is placed on clinical studies, which document their proangiogenic role in diabetic retinopathy and vascular aging. EXPERT OPINION: The pharmacological control of phospholipid moieties in the plasma membrane and the regulation of the MP shedding remains a challenge in the early stage of diabetic retinopathy and vascular aging.
[Show abstract][Hide abstract] ABSTRACT: Background: Complications related to the femoral access substantially contribute to pen-procedural morbidity and mortality. Aim: To evaluate whether the use of a collagen plug as a vascular access closure device (AngioSeal (R), AS) influences complications related to the femoral access and duration of hospitalization for peripheral endovascular interventions. Material and methods: Two hundred and one consecutive patients (59.2% male, age 48-87 years) undergoing angioplasty/stenting of the internal carotid, common carotid, vertebral, subclavian, renal, iliac/femoral, innominate artery or cervical-subclavian bypass were randomized (1: 1 ratio) prior to the intervention to standard manual compression (MC) or AS (6 F or 8 F device used for femoral access with 6-7 F or 8-9 F sheaths respectively). Results: Manual compression was used in 110 patients and AS in 91 patients. There was no difference in the use of 8-9 F and 6-7 F sheats between the two per treatment groups (72.5% vs. 73.6% and 27.5% vs. 26.2%, respectively). Large subcutaneous haematoma, arteriovenous fistula, pseudoaneurysm or femoral artery occlusion requiring surgery occurred in 13.8% MC vs. 4.0% AS for 6-7 F sheaths (p = 0.36) and in 19.7% MC vs. 7.6% AS for 8-9 F sheaths (p = 0.035). Total access site complication rate was 18.2% for MC and 6.6% for AS (p = 0.019). Nine patients with AS (9.9%) required an additional compression dressing 12 h). Overall, AS patients were mobilized earlier (2.9 +/- 2.4 h vs. 14.2 +/- 2.8 h, p = 0.001) and discharged home earlier after the intervention (33.6 +/- 14.16 h vs. 68.1 +/- 34.08 h, p = 0.001). Conclusions: The use of the AngioSeal (R) device for femoral access closure during peripheral interventions (AngioSeal (R) 8 F for 8-9 F sheath and AngioSeal (R) 6 F for 6-7 F sheath) significantly reduces the access site complication rate and allows earlier patient mobilization and discharge from hospital.
Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 03/2012; 1(1):1-7. DOI:10.5114/pwki.2012.27918 · 0.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The rate of early complications of carotid artery stenting (CAS) should not exceed 3% in asymptomatic and 6% in symptomatic patients. However, some recent studies/registries failed to reach this threshold, fueling a debate on the role of CAS in the treatment of patients with carotid artery stenosis.
To evaluate 30-day safety of CAS using different embolic protection devices and different stent types according to the tailored-CAS algorithm and to identify risk factors for complications.
Between 2002 and 2010, we performed 1176 CAS procedures in 1081 patients (age 38-86 years, mean 66.3 ± 8.4 years, 51.5% symptomatic) according to the tailored-CAS algorithm that included extracranial ultrasound and computed tomography angiography to select the most appropriate embolic protection device (EPD) and stent type. Proximal EPD and closed-cell (CC) stents were preferentially used for high-risk lesions (HR - soft/thrombus-containing/tight/ulcerated, 36.14% of all lesions) and in symptomatic patients.
Procedural success rate was 99.8%. In symptomatic patients, proportion of HR lesions was higher (41.1%) than in the asymptomatic group (30.8%, p = 0.001) and the usage of CC stents (76.2% vs 71.7%, p = 0.103) and proximal EPD (P-EPD, 34.8% vs 27.7% among asymptomatic patients, p = 0.010) was more frequent. CC stents were used in 82.4% of CAS procedures involving HR lesions (vs 69.1% for non-HR lesions, p < 0.01), and P-EPD were used in 83.1% of procedures involving HR lesions (vs 2.5% for non-HR lesions, p < 0.001). In-hospital complications included 6 (0.55%) deaths, 1 (0.08%) major stroke and 19 (1.61%) minor strokes. No myocardial infarctions (MI) were noted. Among 7 (0.59%) cases of hyperperfusion syndrome, 2 were fatal. Thirty-day complication rate (death/any stroke/MI) was 2.38%. Age > 75 years was a predictor of death (p = 0.015), and prior neurological symptoms were a predictor of death/stroke (p = 0.030). There were 4 cases of periprocedural embolic cerebral artery occlusion, all treated with combined intracranial mechanical and local thrombolytic therapy.
CAS with EPD and stent type selection on the basis of thorough non-invasive diagnostic work-up (tailored- -CAS) is safe. Advanced age was associated with an increased risk of death and the presence of prior neurological symptoms was a predictor of death/stroke at 30 days. With the tailored-CAS approach, high-risk lesion features (soft/thrombus- -containing/tight/ulcerated) are eliminated as a risk factor. Hyperperfusion syndrome is a severe CAS complication which may lead to intracranial bleeding and death. Acute, iatrogenic embolic cerebral artery occlusion is rare and may be managed by combined intracranial mechanical and local thrombolytic therapy.
Kardiologia polska 01/2012; 70(4):378-86. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between carotid intima-media thickness (CIMT), biomarkers, atherosclerosis extent and a two-year cardiovascular (CV) event risk in patients with arteriosclerosis.
The CIMT, levels of high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-β), interleukin-6 (IL-6), interleukin-10 (IL-10), and NT-proBNP were measured in 279 subjects with atherosclerotic disease, mean age 64.1 ± 9.6 years. The patients were included when they had artery stenosis ≥ 50% in one, two, three or four arterial territories (coronary, supra-aortic, renal and/or lower limb arteries), and this was found in 97, 80, 69 and 33 patients, respectively. During a two-year follow-up, the incidences of CV death, myocardial infarction, ischaemic stroke and lesion progression were recorded.
The identified independent predictors of ≥ 3-territorial stenoses ≥ 50% were CIMT > 1.3 mm (RR 1.72; p < 0.001), hs-CRP > 5 mg/dL (RR 1.28; p = 0.005), IL-6 > 6.5 pg/mL (RR 1.08; p = 0.089), IL-10 (RR 0.86; p = 0.002), diabetes (RR 1.11; p = 0.027), total-cholesterol (RR 1.21; p < 0.001), creatinine (RR 1.15; p = 0.004) and body mass index (RR 0.85; p = 0.001). During a two-year follow-up, CV events occurred in 52 (18.6%) patients. The CIMT > 1.3 mm (p < 0.001), diabetes (p = 0.018), TNF-α > 6 pg/mL (p = 0.018), LDL-cholesterol > 3.35 mmol/L (p = 0.012) and NT-proBNP (p = 0.074) were independent CV event risk factors associated with a 27%, 14%, 15%, 15% and 11% higher CV risk, respectively. However, after adjustment for a baseline location of artery stenosis ≥ 50%, CIMT became a non-significant predictor (p = 0.245).
Levels of hs-CRP, IL-6, IL-10 are independently associated with atherosclerosis extent, while TNF-α and NT- -proBNP are mostly related to a two-year CV event risk. The CIMT > 1.3 mm seems to be a clinically relevant marker associated with atherosclerosis extent and CV risk, although CV event risk is primarily related to the baseline stenosis location.
Kardiologia polska 01/2011; 69(10):1024-31. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) disqualified from an invasive strategy (InvS) are poorly understood. Aim: To investigate the short-term result of a conservative strategy (ConS) in a real-life population of patients with STEMI. Material and methods: 1031 patients with STEMI were retrospectively analyzed. Of these, 194 (18.8%) patients were initially qualified to the ConS. For the remaining 837 (81.2%) patients the InvS was applied. Results: The most frequent reasons for disqualification from an InvS in STEMI patients were the duration of ischemia > 12 h (81.4%), aborted STEMI (9.8%) and anticipated transportation time > 2 h (3.1%). On admission, in the group of InvS, cardiogenic shock was noted in 45 (5.4%) patients. Death within 30 days was more frequently observed in STEMI patients who underwent ConS vs. InvS (13.9% vs. 9.0%, p = 0.037). During initial hospitalization 22 (11.3%) patients who underwent ConS and 34 (4.1%, p < 0.001) with InvS developed symptoms of heart failure (Killip class 2-4). Age (OR 1.07 per year, 95% CI 1.04-1.11, p < 0.0001) and conservative strategy (OR 1.55, 95% CI 0.73-4.86, p = 0.035) were the independent predictors of death within 30 days. Moreover, in patients with InvS cardiogenic shock on admission (OR 52.4, 95% CI 18.7-134.1, p < 0.0001) and in patients with ConS heart failure during hospitalization (OR 10.8, 95% CI 3.2-36.7, p = 0.0002) independently influenced the 30-day mortality (c-statistics 0.83). Conclusions: Duration of ischemia of more than 12 h was the main reason for disqualification from InvS. Applied ConS was associated with higher 30-day mortality when compared to InvS. The symptoms of heart failure were an independent predictor of death within 30 days in patients with ConS.
Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 09/2010; 3(3):97-103. DOI:10.5114/pwki.2010.16349 · 0.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Clinical outcomes of patients with non-ST-segment elevation acute coronary syndrome (NSTACS) disqualified from an invasive strategy (InvS) remain incompletely understood. Aim: To investigate short-term results of a conservative strategy (ConS) in a real-life population of patients with NSTACS. Material and methods: 526 patients with NSTACS were retrospectively analysed. Of these, 335 (63.7%) patients were initially qualified for the ConS. In the remaining 191 (36.3%) patients an InvS was applied. Results: The most frequent reasons for disqualification from an InvS in NSTACS patients were TIMI risk score ≤ 4 (88.0%), lack of patient consent (3.9%) and pulmonary oedema (3.0%). In the group of InvS, cardiogenic shock on admission was found in 11 (5.8%) patients. In patients who underwent ConS and InvS 30-day mortality rate was 6.0 and 10.5% (p = 0.061), respectively, whereas 30-day mortality in non-shock patients assigned to InvS was 7.9% (p = 0.40 vs. ConS). During primary hospitalization, 27 (8.1%) patients with ConS and 7 (3.7%) with InvS developed symptoms of heart failure (Killip 2-4) (p = 0.049). In the group of InvS, cardiogenic shock on admission (OR 49.5, 95% CI 125-234.2, p < 0.0001) and in patients treated conservatively heart failure during hospitalization (OR 27.4, 95% CI 4.8-155.2, p = 0.003) were independent predictors of 30-day mortality (c-statistics 0.70). Conclusions: In NSTACS patients, low risk of complications at baseline was the main reason for disqualification from InvS. The mortality rate within 30 days did not differ significantly between the two therapeutic groups. Symptoms of heart failure during hospitalization were an independent predictor of death within 30 days in NSTACS patients disqualified from InvS.
Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 01/2010; 4(4):147-153. DOI:10.5114/pwki.2010.17627 · 0.15 Impact Factor