Jerzy Sadowski

Publications of Jerzy Sadowski

• Impaired responsiveness to clopidogrel and aspirin in patients with recurrent stent thrombosis following percutaneous intervention for peripheral artery disease.

  Authors: Piotr Mazur, Marzena Frołow, Rafał Niżankowski, Jerzy Sadowski, Anetta Undas

  Platelets. 04/2012;

  Patients with peripheral artery disease (PAD) following peripheral percutaneous transluminal angioplasty (PTA) with stent implantation are prone to stent thrombosis despite treatment with aspirin andPatients with peripheral artery disease (PAD) following peripheral percutaneous transluminal angioplasty (PTA) with stent implantation are prone to stent thrombosis despite treatment with aspirin and clopidogrel. Impaired clopidogrel responsiveness is associated with increased risk of ischemic events in patients following coronary stent implantation. We sought to assess platelet responsiveness to clopidogrel and aspirin in patients with PAD and recurrent stent thrombosis. Platelet aggregation induced by 5 and 20 µmol/l adenosine diphosphate (ADP) and 0.5 mmol/l arachidonic acid (AA), together with platelet reactivity index (PRI) and serum thromboxane B(2) (TXB(2)), were determined in 11 patients with PAD and a history of stent thrombosis (mean, 3.1 ± 1.14) after PTA and in 15 patients with PAD with no such history, also in 11 controls with coronary artery disease (CAD) and previous stent thrombosis. Platelet aggregation to 5 µmol/l ADP was higher in subjects with PAD and stent thrombosis than in those without stent thrombosis (p = 0.0003) and CAD subjects (p = 0.002). Aggregation induced by 20 µmol/l ADP was higher in PAD group with stent thrombosis than in PAD subjects without thrombosis (p = 0.004). The PAD group with stent thrombosis had higher AA-induced platelet aggregation than CAD controls (p = 0.007) and serum TXB(2) concentrations higher than PAD group without thrombosis (p = 0.002) and CAD group (p = 0.02). Concluding, platelet responsiveness to clopidogrel and aspirin is impaired in patients with PAD and recurrent stent thrombosis following PTA, as compared with similar individuals with CAD, and PAD with no history of stent thrombosis. This indicates that atherosclerosis burden affects platelet function and might contribute to stent thrombosis following percutaneous intervention in peripheral arteries.

• Thoracoscopic epicardial ablation of left and right atrium: beating heart procedure in patients with atrial fibrillation.

  Authors: Krzysztof Bartuś, Andy C Kiser, Jacek Majewski, Bogusław Kapelak, Janusz Konstanty-Kalandyk, Jacek Lelakowski, Jacek Bednarek, Stanisław Bartuś, Karol Wierzbicki, Robert Sobczyński, Jerzy Sadowski

  Polskie Archiwum Medycyny Wewnetrznej. 04/2012;

  INTRODUCTION Atrial fibrillation(AF) is a common arrhythmia affecting ca. 1-2% of the general population. OBJECTIVES The objective of the study was to evaluate the efficacy and safety ofINTRODUCTION Atrial fibrillation(AF) is a common arrhythmia affecting ca. 1-2% of the general population. OBJECTIVES The objective of the study was to evaluate the efficacy and safety of thoracoscopic ablation in AF patients. PATIENTS AND METHODS 25 patients aged from 42-77(mean 56.4 years) with persistent or longstanding persistent AF were selected. Thoracoscopic epicardial ablation of the right atrium, pulmonary veins and left atrium was performed on the beating heart using Cox MAZE III based diagram, via 3 ports and 2 cm incision below the xiphoid. Exit block was always attempted. Patients were prospectively followed up(FU) for 12 months(M) after the procedure. ECG and 24 h Holter examination was used to confirm results. RESULTS Conduction block across ablation lines was achieved in 21 (84%) patients. At 1 M FU sinus rhythm (SR) was observed in 18 out of the 20 patients. At 3 M FU SR was observed in 19 patients (76%). Two patients had atrial flutter, while three still experienced AF. At 6 M FU SR was observed 21 patients (84%); two patients had AF, one patient atrial flutter, one patient had a pacemaker implanted. Results of the FU performed at one year did not differ from the 6 M FU results. No changes in the sizes of left atria and left ventricular ejection fractions, no deaths, stroke, TIA nor infectious complications were observed. CONCLUSIONS The efficacy of epicardial thoracoscopic ablation of left and right atria was high, reaching 84% during a 12-month follow-up period. No significant complications were observed in the postoperative course, except for the need for pacemaker implantation in one of the patients.

• Factors associated with the presence of circulating active tissue factor and activated factor XI in stable angina patients.

  Authors: Michał Ząbczyk, Saulius Butenas, Dariusz Plicner, Kamil Fijorek, Jerzy Sadowski, Anetta Undas

  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 02/2012; 23(3):189-94.

  Circulating active tissue factor (TF) and activated factor XI (FXIa) have been detected in subgroups of acute coronary syndromes (ACSs) and stable angina patients. We sought to evaluate theCirculating active tissue factor (TF) and activated factor XI (FXIa) have been detected in subgroups of acute coronary syndromes (ACSs) and stable angina patients. We sought to evaluate the determinants of active TF and FXIa in stable angina patients. We studied 124 consecutive stable angina patients. Recent ACS, atrial fibrillation, and anticoagulant therapy were the exclusion criteria. Plasma active TF and FXIa were determined by measuring the response to inhibitory antibodies. T helper 1 lymphocyte (Th1) and Th2 responses were assessed in plasma by interleukin (IL)-4, IL-6, IL-8, IL-10, IL-18, interferon-γ, and tumor necrosis factor-α, oxidative stress by 8-isoprostaglandin F2α (8-iso-PGF2α), and coagulation by prothrombin fragments F1+2 (F1+2) and free TF pathway inhibitor (f-TFPI). TF and FXIa activity were detected in 25 (20.2%) and 49 (39.5%) stable angina patients, respectively. Both factors were found in 23 (18.5%) patients. Patients with detectable TF or FXIa had higher F1+2, 8-iso-PGF2α, IL-6, but not other cytokines, and lower f-TFPI (all P < 0.001) compared with the remainder. There were no intergroup differences with regard to cardiovascular risk factors or medication. Multivariate analysis showed that F1+2 and f-TFPI were the only independent predictors of the TF presence, whereas 8-iso-PGF2α and F1+2 predicted the presence of FXIa in stable angina patients. In stable angina patients, circulating active TF and FXIa are associated with enhanced thrombin formation, with a minor effect of inflammatory mediators. Moreover, FXIa is also related to oxidative stress, indicating additional links between coagulation and free radical generation in stable angina.

• Single nucleotide polymorphisms may be useful as short-term predictors after coronary artery by-pass grafting surgery: the role of FGB g.4884C>T polymorphism.

  Authors: Ewa Stępień, Bogusław Kapelak, Rafał Drwiła, Jerzy Sadowski

  Kardiologia polska. 01/2012; 70(1):109-10.

• Intrapericardial ectopic thyroid gland mimicking cardiac tumor.

  Authors: Andrzej Gackowski, Artur Pietrucha, Tomasz Miszalski-Jamka, Pawel Rostoff, Jerzy Sadowski, Jadwiga Nessler

  International journal of cardiology. 11/2011;

• Does Diabetes Accelerate the Progression of Aortic Stenosis through Enhanced Inflammatory Response within Aortic valves?

  Authors: Joanna Natorska, Ewa Wypasek, Grzegorz Grudzień, Dorota Sobczyk, Grzegorz Marek, Grzegorz Filip, Jerzy Sadowski, Anetta Undas

  Inflammation. 09/2011;

  Diabetes predisposes to aortic stenosis (AS). We aimed to investigate if diabetes affects the expression of selected coagulation proteins and inflammatory markers in AS valves. Twenty patients withDiabetes predisposes to aortic stenosis (AS). We aimed to investigate if diabetes affects the expression of selected coagulation proteins and inflammatory markers in AS valves. Twenty patients with severe AS and concomitant type 2 diabetes mellitus (DM) and 40 well-matched patients without DM scheduled for valve replacement were recruited. Valvular tissue factor (TF), TF pathway inhibitor (TFPI), prothrombin, C-reactive protein (CRP) expression were evaluated by immunostaining and TF, prothrombin, and CRP transcripts were analyzed by real-time PCR. DM patients had elevated plasma CRP (9.2 [0.74-51.9] mg/l vs. 4.7 [0.59-23.14] mg/l, p = 0.009) and TF (293.06 [192.32-386.12] pg/ml vs. 140 [104.17-177.76] pg/ml, p = 0.003) compared to non-DM patients. In DM group, TF-, TFPI-, and prothrombin expression within valves was not related to demographics, body mass index, and concomitant diseases, whereas increased expression related to DM was found for CRP on both protein (2.87 [0.5-9]% vs. 0.94 [0-4]%, p = 0.01) and transcript levels (1.3 ± 0.61 vs. 0.22 ± 0.43, p = 0.009). CRP-positive areas were positively correlated with mRNA TF (r = 0.84, p = 0.036). Diabetes mellitus is associated with enhanced inflammation within AS valves, measured by CRP expression, which may contribute to faster AS progression.

• Mechanisms of increased vascular superoxide production in human varicose veins.

  Authors: Bartłomiej Guzik, Maciej Chwała, Paweł Matusik, Dominik Ludew, Dominik Skiba, Grzegorz Wilk, Wojciech Mrowiecki, Bogdan Batko, Andrzej Cencora, Bogusław Kapelak, Jerzy Sadowski, Ryszard Korbut, Tomasz J Guzik

  Polskie Archiwum Medycyny Wewnętrznej. 08/2011; 121(9):279-86.

  Varicose vein disease is one of the most common morbidities in the developed countries. Recent studies have shown that oxidative stress is increased in varicose veins (VV) and venous insufficiency.Varicose vein disease is one of the most common morbidities in the developed countries. Recent studies have shown that oxidative stress is increased in varicose veins (VV) and venous insufficiency. However, the exact mechanisms of oxidative stress in VV remain unknown. The aim of the study was to measure superoxide anion production and analyze its enzymatic sources in VV in comparison with control human saphenous veins (HSV). Superoxide production was also compared between the proximal and distal segments of the veins. Proximal and distal segments of varicose veins (14 patients, aged 52 ±3.5 years) and control veins (15 patients, aged 56 ±4 years) were obtained during VV removal or elective coronary artery bypass graft surgery, respectively. Subjects were matched for age, sex, and the major risk factors for atherosclerosis. Superoxide was measured by lucigenin-enhanced chemiluminescence (5 μmol/l) in the presence and absence of oxidase inhibitors. Superoxide production was increased in VV compared with control HSV. This increase was particularly evident in the distal segments of VV. There was a significant correlation between superoxide production in the proximal and distal segments of HSV but not of VV. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and uncoupled nitric oxide synthase (NOS) were the major sources of superoxide in VV, because their inhibitors greatly attenuated superoxide production in VV. NADPH oxidases and NOS could represent valuable drug targets for pharmacological treatment and prevention of varicose vein disease. Oxidative stress may provide a link between endothelial dysfunction, inflammation, and immune activation and the development of chronic venous dysfunction.

• Effect of the E-selectin gene polymorphism (S149R) on platelet activation and adverse events after coronary artery surgery.

  Authors: Ewa Stępień, Sylwia Krawczyk, Bogusław Kapelak, Robert Sobczyński, Jarosław Stoliński, Ewa Wypasek, Anetta Undas, Jerzy Sadowski

  Archives of medical research. 08/2011; 42(5):375-81.

  A common single nucleotide polymorphism in the E-selectin (SELE) gene S149R results in the loss of E-selectin ligand binding specificity. The 149R allele has been associated with severeA common single nucleotide polymorphism in the E-selectin (SELE) gene S149R results in the loss of E-selectin ligand binding specificity. The 149R allele has been associated with severe cardiovascular diseases. We hypothesized that S149R may regulate platelet activation after stimuli associated with perioperative procedures in patients undergoing isolated coronary artery bypass grafting (CABG). Associations between the S149R polymorphism and an increased risk of perioperative acute thrombotic events with regards to a platelet count and activity were analyzed. In elective CABG patients (n = 152) we analyzed associations between S149R polymorphism and an increased risk of perioperative acute thrombotic events with regard to platelet count and activity. The S149R SELE gene polymorphism was determined by real-time polymerase chain reaction. Platelet count and activation marker (β-thromboglobulin-βTG) were evaluated. Prevalence of the S149R genotypes was as follows: 81.8% (n = 121) of homozygotes (149SS), 15.5% (n = 23) of heterozygotes and 2.7% (n = 4) of homozygotes (149RR). The 149R allele carriers had significantly higher postoperative βTG levels than the homozygotes (97 [79-120] vs. 76 [66-91] IU/mL, p = 0.03). Sixteen patients had adverse events: myocardial infarction (n = 14), stroke (n = 1) and fatal pulmonary embolism (n = 1). Twelve patients were carriers of the 149R allele. Relative risk (RR) of postoperative adverse events in the 149R allele carriers was 2.03 with 95% CI (1.05-3.03). Postoperative platelet activation is related to the S149R polymorphism, which enhances the risk of adverse events after CABG.

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• Treatment strategies in severe symptomatic carotid and coronary artery disease.

  Authors: Karolina Dzierwa, Piotr Pieniazek, Piotr Musialek, Jacek Piatek, Lukasz Tekieli, Piotr Podolec, Rafał Drwiła, Marta Hlawaty, Mariusz Trystuła, Rafał Motyl, Jerzy Sadowski

  Medical science monitor : international medical journal of experimental and clinical research. 08/2011; 17(8):RA191-197.

  Coexistent carotid artery stenosis (CS) and multivessel coronary artery disease (CAD) is not infrequent. One in 5 patients with multivessel CAD has a severe CS, and CAD incidence reaches 80% in thoseCoexistent carotid artery stenosis (CS) and multivessel coronary artery disease (CAD) is not infrequent. One in 5 patients with multivessel CAD has a severe CS, and CAD incidence reaches 80% in those referred for carotid revascularization. We reviewed treatment strategies for concomitant severe CS and CAD. We performed a literature search (MEDLINE) with terms including carotid artery stenting (CAS), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), stroke, and myocardial infarction (MI). The main therapeutic option for CS-CAD has been (simultaneous or staged) CEA-CABG. This, however, is associated with a high risk of MI (in those with CEA prior to CABG) or stroke (CABG prior to CEA), and the cumulative major adverse event rate (MAE - death, stroke or MI) reaches 10-12%. With increasing adoption of CAS, a sequential strategy of CAS followed by CABG has emerged. Registries (usually single-centre) indicate an MAE rate of ≈7% for CAS followed by CABG (frequently after >30 days, due to double antiplatelet therapy). Recently, 1-stage CAS-CABG has been introduced. This involves different antiplatelet regimens and, in some centers, preferred off-pump CABG, with a cumulative MAE of 1.4-4.5%. No randomized trial comparing different treatment strategies in CS-CAD has been conducted, and thus far reported series are prone to selection/reporting bias. In addition to the established surgical treatment (CEA-CABG, sequential/simultaneous), hybrid revascularization (CAS-CABG) is emerging as a viable therapeutic option. Larger, preferably multi-centre, studies are required before this can become widely applied.

• Importance of evaluating conduction block in radiofrequency ablation for atrial fibrillation.

  Authors: Borut Gersak, Andy C Kiser, Krzysztof Bartus, Jerzy Sadowski, Wolfgang Harringer, Michael Knaut, Gerhard Wimmer-Greinecker, Andrej Pernat

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 06/2011; 41(1):113-8.

  Atrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia. Anti-arrhythmic drugs may be used to suppress ectopic foci and interrupt reentry circuits, but are often insufficient toAtrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia. Anti-arrhythmic drugs may be used to suppress ectopic foci and interrupt reentry circuits, but are often insufficient to treat recurrent AF and have a number of adverse effects. Alternative therapies, such as catheter and surgical ablation, have been explored. This investigation examines the importance of assessing exit block when performing surgical ablation during beating-heart treatment of AF. This was an evaluation of pooled data from multicenter prospective results obtained in AF patients who received ablation with a new, irrigated, vacuum-integrated device that creates linear lesions during beating-heart/open-chest or minimally invasive, port-access procedures. Electrocardiogram or Holter data were collected intra-operatively and at 1, 3, 6, and 12 months. Outcomes were also evaluated for patients who were or 'were not' tested for exit block following the ablation procedure. A total of 93 patients were treated (61 open-chest surgeries, 32 port-access procedures). There were no device-related complications and no operative mortality. At 341 days' average follow-up, 71/86 (83%) patients were free from AF, 66/86 (77%) were in sinus rhythm, and 60/86 (70%) were free from AF and off Class I and III anti-arrhythmic drugs (AADs). At 12 months, 23/23 (100%) patients with exit block confirmed were AF free compared with 13/21 (62%) patients with exit block not tested (p≤0.01, Fisher's exact test); 20/23 (87%) were in sinus rhythm compared with 12/21 (57%) patients with exit block not tested (p≤0.05, Fisher's exact test); and 20/23 (87%) were AF free without Class I and III AADs compared with 10/21 (48%) patients with exit block not tested (p≤0.01, Fisher's exact test). Both open-chest and port-access procedures yielded decreases in left-atrial size from baseline to 6 months' follow-up. Patients undergoing port-access procedures also observed an increase in left-ventricular ejection fraction, which was also significant at 6 months. Patients in whom exit block was confirmed following an ablation procedure were more likely to have successful clinical outcomes. Since testing for exit block must be performed on a beating heart, total epicardial beating-heart ablation may provide an important treatment for AF, providing intra-operative feedback indicative of long-term outcomes.

• Increased thrombin generation and platelet activation are associated with deficiency in high molecular weight multimers of von Willebrand factor in patients with moderate-to-severe aortic stenosis.

  Authors: Joanna Natorska, Ksenia Bykowska, Marta Hlawaty, Grzegorz Marek, Jerzy Sadowski, Anetta Undas

  Heart (British Cardiac Society). 05/2011; 97(24):2023-8.

  High molecular weight von Willebrand factor (vWF) multimers (HMWM) are often deficient in patients with severe aortic stenosis (AS) owing to shear stress-enhanced proteolysis of vWF. It has also beenHigh molecular weight von Willebrand factor (vWF) multimers (HMWM) are often deficient in patients with severe aortic stenosis (AS) owing to shear stress-enhanced proteolysis of vWF. It has also been reported that AS is associated with increased activation of blood coagulation. To investigate whether patients with AS with a deficiency in vWF HMWM have enhanced thrombin generation and platelet activation in vivo. Based on the analysis of vWF HMWM performed using immunolocalisation, 11 subjects with vWF HMWM deficiency (low %HMWM group) were identified and compared with 42 patients with AS with a normal distribution of vWF HMWM (normal %HMWM group). Plasma thrombin markers thrombin-antithrombin complexes (TAT) and prothrombin factor 1+2 (F1.2) plus platelet activation markers soluble CD40 ligand (sCD40L), β-thromboglobulin and P-selectin were also measured. 48 consecutive patients with severe AS and five with moderate AS, free of angiographically-proven coronary artery disease and clinically overt bleeding, were studied. Patients in the low %HMWM group had 34.8% higher maximal transvalvular gradient (p = 0.0003) and 44.8% higher mean gradient (p = 0.0002) than those in the normal %HMWM group. Thrombin formation was enhanced in the low %HMWM group (F1.2, 284.5 ± 63.7 vs 216.9 ± 62.5 pmol/l, p = 0.004; thrombin-antithrombin, 4.89 ± 1.3 vs 4.06 ± 0.9 μg/l, p = 0.02) and both markers showed inverse correlations with the percentage of vWF HMWM (r = -0.59, p = 0.002; r = -0.42, p = 0.03, respectively). In the low %HMWM group sCD40L (279.4 ± 60.7 vs 221.4 ± 41.7 pmol/l, p = 0.003) and β-thromboglobulin (73.1 ± 9.2 vs 64.5 ± 8.5 IU/ml, p = 0.04), but not P-selectin, were also higher than in the remaining patients with AS. Patients with advanced AS deficient in vWF HMWM are characterised by enhanced thrombin formation and platelet activation. This observation indicates the ambivalent impact of high shear stress in AS on haemostasis and might help explain two aspects of AS-Heyde syndrome and increased risk of thromboembolism.

• Fibrinogen Beta-Chain -C148T Polymorphism is Associated with Increased Fibrinogen, C-Reactive Protein, and Interleukin-6 in Patients Undergoing Coronary Artery Bypass Grafting.

  Authors: Ewa Wypasek, Ewa Stepien, Malgorzata Kot, Dariusz Plicner, Boguslaw Kapelak, Jerzy Sadowski, Anetta Undas

  Inflammation. 04/2011;

  The fibrinogen beta-chain (FGB) -C148T polymorphism is linked with plasma fibrinogen concentration in the general population. We examined whether the -C148T polymorphism is associated with pre- andThe fibrinogen beta-chain (FGB) -C148T polymorphism is linked with plasma fibrinogen concentration in the general population. We examined whether the -C148T polymorphism is associated with pre- and early postoperative levels of fibrinogen, C-reactive protein (CRP), and interleukin-6 (IL-6) in 243 consecutive patients undergoing coronary artery bypass grafting (CABG) surgery. Plasma inflammatory markers were measured prior to and 5-7 days after surgery. The -C148T polymorphism was analyzed with the restriction fragment-length polymorphism method. The genotype distribution was as follows: CC-142 (58%), CT-85 (35%), and TT-16 (7%). Carriers of the -148T allele had higher preoperative plasma fibrinogen (4.42 ± 0.14 vs. 4.07 ± 0.11 mg/L, p = 0.04) and CRP levels (7.49 ± 1.2 vs. 4.26 ± 1.0 mg/L, p = 0.04) compared with non-carriers; 5 to 7 days after CABG, patients carrying -148T allele had increased CRP (70.4 ± 5.0 vs. 51.6 ± 4.25 mg/L, p = 0.005) and IL-6 levels (22.34 ± 2.64 vs. 15.53 ± 2.28 pg/L, p = 0.05), but not fibrinogen, compared with the remaining subjects. In-hospital nonfatal stroke occurred more frequently in -148T allele carriers (4% vs. 0%, p = 0.02). No genotype-associated differences were found in the occurrence of postoperative myocardial infarction and death. Presence of the -148T allele has also been associated with longer intensive care stay and intubation time (p = 0.01). Multivariate analysis identified the CT+TT genotype as an independent predictor of pre- and postoperative CRP levels. The results indicate that the presence of the -148T FGB allele determines higher pre- and postoperative levels of inflammatory markers, which might be associated with in-hospital clinical outcomes.

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• Clinical experience with the ATS 3f Enable® Sutureless Bioprosthesis.

  Authors: Sven Martens, Jerzy Sadowski, Friedrich S Eckstein, Krzysztof Bartus, Boguslaw Kapelak, Hans-Hinrich Sievers, Christian Schlensak, Thierry Carrel

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 02/2011; 40(3):749-55.

  The ATS 3f Enable® Bioprosthesis is a self-expanding valve with a tubular design that allows for decreased leaflet stress and preservation of aortic sinuses. We report the midterm results of aThe ATS 3f Enable® Bioprosthesis is a self-expanding valve with a tubular design that allows for decreased leaflet stress and preservation of aortic sinuses. We report the midterm results of a prospective, multicenter clinical study evaluating the safety and efficacy of this stented bioprosthesis in patients undergoing isolated aortic valve replacement with or without concomitant procedures. A total of 140 patients (mean age: 76 ± 6 years; 63% of patients in New York Heart Association (NYHA) stage III-IV) received the ATS 3f Enable(®) Bioprosthesis in 10 European centers between March 2007 and December 2009. The total accumulated follow-up is 121.8 patient-years. Valve implantation resulted in significant improvement of patients' symptoms. Mean systolic gradient was 9.04 ± 3.56 and 8.62 ± 3.16 mm Hg with mean effective orifice area of 1.69 ± 0.52 and 1.67 ± 0.44 at 6 months and 1 year, respectively. No significant transvalvular aortic regurgitation was observed. Early complications included three major paravalvular leaks (PVL; 2.1%) resulting in valve explantation and one thrombo-embolic (0.7%) event. All, but one, of the early PVLs were evident intra-operatively with the medical decision made not to reposition or resolve immediately. Late adverse events included three explantations (2.5% per patient-year): one due to PVL and two due to endocarditis. There was an additional case of late endocarditis (0.8% per patient-year) that resolved by medical management. No structural deterioration, valve-related thrombosis or hemolysis was documented. The sutureless valve implantation technique is feasible and safe with the ATS 3f Enable Bioprosthesis. Valve implantation resulted in excellent hemodynamics and significant clinical improvement. Overall, these data confirm the safety and clinical utility of the Enable® Bioprosthesis for aortic valve replacement.

• Development, Implementation, and Multicenter Clinical Validation of the TeleDICOM - Advanced, Interactive Teleconsultation System.

  Authors: Andrzej Gackowski, Lukasz Czekierda, Anton Chrustowicz, Jacek Cala, Michal Nowak, Jerzy Sadowski, Piotr Podolec, Mieczyslaw Pasowicz, Krzysztof Zielinski

  J. Digital Imaging. 01/2011; 24:541-551.

• [Comment to article New era in the treatment of secondary aortic stenosis.].

  Authors: Jerzy Sadowski, Janusz Konstanty-Kalandyk, Karol Wierzbicki

  Kardiologia polska. 01/2011; 69(2):115.

• [Catheter-based renal sympathetic denervation for the treatment of resistant arterial hypertension in Poland - experts consensus statement].

  Authors: Adam Witkowski, Andrzej Januszewicz, Jacek Imiela, Krzysztof Narkiewicz, Grzegorz Opolski, Olgierd Rowiński, Jerzy Sadowski, Dariusz Dudek, Leszek Bryniarski, Robert J Gil, Marcin Adamczak, Stefan Grajek, Jacek Kądziela, Aleksander Prejbisz, Maciej Nowicki

  Kardiologia polska. 01/2011; 69(11):1208-11.

• [Percutaneous coronary intervention and aortic valve implantation in a patient with breast cancer].

  Authors: Paweł Kleczyński, Danuta Sorysz, Lukasz Rzeszutko, Jacek Legutko, Bogusław Kapelak, Jerzy Sadowski, Jacek Dubiel, Dariusz Dudek

  Kardiologia polska. 01/2011; 69(11):1165-7.

  We present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronaryWe present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronary revascularisation, transapical aortic valve implantation and mastectomy.

• [Hybrid ablation of the left atrium on beating-heart - initial experience].

  Authors: Krzysztof Bartuś, Jacek Bednarek, Jacek Majewski, Bogusław Kapelak, Jacek Lelakowski, Stanisław Bartuś, Krzysztof Oleś, Jerzy Sadowski

  Kardiologia polska. 01/2011; 69(5):513-5; discussion 516.

• Increased prevalence of cardiovascular risk factors in patients with acute coronary syndrome and indications for treatment with oral anticoagulation.

  Authors: Michał Owsiak, Agnieszka Pelc-Nowicka, Leszek Badacz, Jacek Dubiel, Dariusz Dudek, Grzegorz Gajos, Janusz Grodecki, Piotr Jankowski, Kalina Kawecka-Jaszcz, Ewa Mirek-Bryniarska, Jadwiga Nessler, Piotr Podolec, Jerzy Sadowski, Wiesława Tracz, Michał Zabojszcz, Krzysztof Żmudka, Leszek Bryniarski

  Kardiologia polska. 01/2011; 69(9):907-12.

  Antiplatelet drugs currently constitute the basic treatment of coronary artery disease (acute coronary syndrome [ACS], stable angina and patients treated with percutaneous coronary interventionsAntiplatelet drugs currently constitute the basic treatment of coronary artery disease (acute coronary syndrome [ACS], stable angina and patients treated with percutaneous coronary interventions [PCI]). The number of patients with indication for dual antiplatelet therapy with comorbidities with high thrombo-embolic risk (such as atrial fibrillation [AF], venous thrombotic disease, valvular diseases) is increasing. That is why the need for simultaneous administration of dual antiplatelet and oral anticoagulant therapy (triple therapy) has become more common recently. The AF is the most common indication for chronic anticoagulation. Because of the lack of large randomised trials regarding triple therapy, characteristics of this group has not been well established. To assess the presence of cardiovascular (CV) risk factors and concomitant diseases in patients with ACS requiring triple therapy. Retrospective analysis included 2279 patients diagnosed with ACS who were admitted to the Departments of Cardiology in Cracow in 2008. In this group, 365 (16%) patients had indications for chronic anticoagulation. Demographic and clinical characteristics of these patients were compared with those of patients included in other published registries. Patients requiring triple therapy were aged 73.2 ± 9.5 years. Hypertension was diagnosed in 80%, hyperlipidaemia in 63%, smoking in 36%, prior myocardial infarction in 33%, prior stroke in 15%, previous treatment with PCI in 13%, coronary artery bypass grafting in 7%, diabetes in 36%, heart failure in 46%, anaemia in 33% and chronic ulcer disease or gastroesophageal reflux disease in 9%. The mean left ventricular ejection fraction was 46 ± 15%. Compared with other registries of patients without indications for triple therapy, our patients had significantly more frequently hypertension, diabetes and were older. Patients after an ACS requiring triple therapy have more often a history of comorbidities and CV risk factors when compared with the group of patients with ACS without indication for triple therapy.

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

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

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

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