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ABSTRACT: The purpose of this study was to present the outcomes of treatment of cardiogenic shock (CS) complicating acute myocardial
infarction (AMI) among patients hospitalized from 1999 through 2006. The study enrolled 1003 patients. Group 1 comprised 87
patients presenting with AMI complicated with CS, whereas Group 2 comprised 916 patients presenting with AMI without CS symptoms.
Determination of invasive treatment was according to standard guidelines. The endpoint comprised death, stroke, and reocclusion/reinfarction.
Follow-up was confined to the intra-hospital period. CS was observed more frequently in cases of ST-elevation MI (STEMI) and
right ventricular MI. The transportation and door-to-needle time were shorter in Group 1. CS patients were characterized by
a more severe coronary artery disease, higher maximal creatinine kinase levels, lower global ejection fractions, and increased
incidence of atrioventricular conduction disorders. The efficacy of percutaneous coronary intervention (PCI) was 82.26% in
Group 1 and 95.03% in Group 2. Death occurred in 33.3% of CS patients and in 3.6% of AMI patients (p<0.0001). Our study proved
that in a short-term follow-up, PCI is a procedure of high efficacy in CS patients. The short-term follow-up precluded a conclusion
of statistically significant benefits from the shortening of the transportation and door-to-needle time.
KeywordsMyocardial Infarction–Shock–Myocardial Revascularization–Angioplasty
Central European Journal of Medicine 04/2012; 6(2):213-219. · 0.31 Impact Factor
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ABSTRACT: Tako-tsubo cardiomyopathy, known since 1990, is described as hypo/akinesis of apical heart segments with the hyperkinesis of the basis of the heart which mimics the shape of a traditional Japanese octopus trap. (Cardiol J 2012; 19, 5: 521-523).
Cardiology journal 01/2012; 19(5):521-3. · 1.31 Impact Factor
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ABSTRACT: Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs).
The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS).
Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49 ± 4.09 vs. 4.81 ± 2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016).
Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.
Yonsei medical journal 01/2012; 53(1):58-67. · 0.77 Impact Factor
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ABSTRACT: A case of a 51-year-old woman with symptoms of non-ST-segment elevation acute coronary syndrome and concomitant atrial flutter is presented. Patient underwent atrioventricular septal defect repair in childhood. Coronary angiography showed total occlusion of left main coronary artery and massive collateral network originating from right coronary artery supplying entire left coronary artery. Ablation of atrial flutter had been performed and patient was subsequently submitted to mitral valve replacement, tricuspid valvuloplasty and coronary artery bypass grafting. The potential causes of left main occlusion are in this case discussed.
Kardiologia polska 01/2012; 70(5):533-5; discussion 536. · 0.51 Impact Factor
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ABSTRACT: The study concerns determination of disturbances of the oxidative-antioxidative balance in patients with heart failure. The study group consisted of 37 patients, having the average age of 42.3 +/- 12.3 years, suffering from idiopathic or inflammatory heart failure. The patients have been qualified as degree II/III in accordance with NYHA scale. A statistically significant increase of anty-oxLDL level (254.28 +/- 80.79 vs 196.64 +/- 83.11 mU/ml; p<0.01) and malondialdehyde level (4.86 +/- 1.74 vs 3.71 +/- 1.19 micromol/l; p<0.05) has been demonstrated after 6-month observation. No statistically significant differences have been found for the activity of total superoxide dismutase (SOD) and its isoenzymes--(SOD-Mn) and (SOD-ZnCu). The results of the study indicate that no changes in SOD activity and increase in lipid peroxidation products level may lead to generation of oxidative stress may play an important role in the pathogenesis of heart failure.
Wiadomości lekarskie (Warsaw, Poland: 1960) 01/2011; 64(2):75-8.
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ABSTRACT: Primary pulmonary arterial hypertension (PPH) is a rare disease of undetermined origin and fatal prognosis. A better prognosis is associated with at least 20% reduction of either pulmonary artery pressure or pulmonary vascular resistance ("responders") in acute vasodilatory trials. Prostacycline (PGI2) or nitric oxide (NO) administration promises valuable results. NO is one of the most powerful vasodilating agents, endogenously produced by endothelial cells. It migrates from these cells to smooth muscle cells and stimulates production of cGMP, that induces smooth muscle relaxation. cGMP is hydrolyzed by 5-phopshodiesterase (PDE-5). Several papers documenting hypotensive effect in pulmonary circulation of specific PDE5 inhibitor--sildenafil (Viagra--Pfizer) have been published recently. We present a case report of a 26 year old female patient with PPH--"nonresponder" in a trial with NO--and NO responder after sildenafil administration. Initial values were: mean pulmonary artery pressure (mPAP) was 58 mmHg, pulmonary vascular resistance was 10.9 Wood's units. mPAP and PVR during NO inhalation (40 ppm) decrease from 62 to 54 mmHg and from 11.4 to 10.3 Wood's units, respectively. Measurements performed 60 minutes after 50 mg of sildenafil orally disclosed a 19% reduction of mPAP and 21% reduction of PVR. NO inhalation caused further decrease of both parameters: mPAP was decreased for additional 28% and PVR for additional 36% in comparison to initial results. Neither peripheral hypotension nor other side effects were observed. A month-long administration of sildenafil in a dose 2 x 25 mg daily reduced mPAP and PVR to values reported for the acute trial. Physical capability improved also. It was assessed as increased distance in a six-minute-walk test (280 vs. 400 m in the first week of treatment, and 330 m in a fourth week of treatment). Echocardiography showed moderate decrease of right ventricle and right atrium diameters, along with decrease of the degree of relative tricuspid regurgitation with unchanged maximal velocity of regurgitant wave. Specific PDE-5 inhibitors might be an attractive alternative in the treatment of pulmonary hypertension in case the above noted observations are confirmed.
Przegla̧d lekarski 02/2005; 62(2):135-8.
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Damian Kawecki,
Krzysztof Szczurek-Katański, Wojciech Jacheć,
Jacek Szyguła,
Piotr Walichiewicz,
Andrzej Tomasik,
Przemysław Wilczewski,
Marcin Fudal,
Renata Rybczyk,
Grazyna Glanowska,
Jan Wodniecki
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ABSTRACT: The aim of the study is the analysis of own results of myocardial infarction treatment using percutaneous coronary intervention (PCI) in the setting of twenty-four hour long hemodynamic service. Between 01.12.1998 and 31.12.2001 249 patients with diagnosis of acute myocardial infarction were admitted to our Department. Their mean age was 58 years, men -73.5%, median of pain duration was 4 hours, diabetes occurred in 11.6%, hypertension in 37.3%, dyslipidemia occurred in 14%, smokers constituted 59% of patients. 60.2% of patients were in Killip class I, 18.5% in class II, 8.0% in class III and 13.3% in class IV. Anterior and/or lateral myocardial infarction was diagnosed in 105 patients, inferior and/or posterior in 144 patients. Angiography was performed in 225 patients, PCI was performed in 178. TIMI 3 flow was achieved in 76% of patients with shock and 90% of patients without shock. Multivessel coronary artery disease was present in 71% of patients. 30-day mortality in patients treated with PCI was 11.8%, after exclusion of III and IV Killip class patients mortality was 4.3%. 30-day mortality in group of patients with cardiogenic shock was 38.0%. Relative risk of death in patients in III and IV Killip class was higher for these treated conservatively: IV class -1.51 (p = 0.075), III and IV class (common group) -1.38 (p = 0.064). In the year of 2001 30-day mortality among the patients in I and II Killip class treated with PCI was 2.43%. CONCLUSIONS: 1. Primary percutaneous coronary intervention in the treatment of myocardial infarction improves prognosis in group of patients with cardiogenic shock in 30-day observation. 2. 11.8% mortality observed in our PCI treated group is associated in our opinion with occurrence of multivessel coronary disease in 71% of patients.
Polskie archiwum medycyny wewnȩtrznej 07/2003; 109(6):617-22. · 1.37 Impact Factor
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ABSTRACT: We aimed to assess the oxidant/antioxidant status within the ex vivo human coronary endarterectomy samples.
To achieve this, we measured products of lipid oxidation (malondialdehyde, 7-ketocholesterol), lipids (cholesterol, cholesteryl esters) and vitamin E in endarterectomy samples.
Content of malondialdehyde in the plaque ranged from 0.23 to 37.36 microg/g. Unesterified cholesterol content ranged from 0.30 to 1.94 mg/g. It was 9.04+/-4.32% of total cholesterol. Total cholesterol content ranged from 1.73 to 23.69 mg/g. Cholesteryl palmitate content ranged from 0.57 to 19.10 mg/g, which is 11.43-60.86% of the total esters (mean+/-SD 40.27+/-18.42%). Cholesteryl oleate content ranged from 0.24 to 5.76 mg/g, being 9.97-21.81% of total esters (mean+/-SD 14.35+/-4.51%). Cholesteryl linoleate content ranged from 1.05 to 8.21 mg/g, being 17.84-45.15% of total esters (mean+/-SD 30.78+/-11.69%). Cholesteryl arachidonate content ranged from 0.51 to 4.20 mg/g, which is 7.56-22.87% of total esters (mean+/-SD 14.60+/-5.60%). The cholesteryl linoleate/cholesteryl oleate ratio (CL/CO) ranged from 1.01 to 4.33. Content of 7-ketocholesterol in the plaque ranged from 0.0 to 577.5 ng/g of wet weight. The 7-ketocholesterol/total cholesterol ratio was 0.003+/-0.003% (range from 0.0% to 0.008%). The 7-ketocholesterol/unesterified cholesterol ratio was 0.024+/-0.023% (range from 0.0% to 0.066%). The plaque content of vitamin E ranged from 0.0 to 40.9 microg/g of wet weight.
The present study, comprising measurements of lipids, products of lipid peroxidation and vitamin E in 12 human coronary endarterectomy samples, lends the evidence for ongoing lipid peroxidation within an atherosclerotic lesion.
Clinica Chimica Acta 05/2003; 330(1-2):121-9. · 2.54 Impact Factor
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ABSTRACT: Endovascular application of ionizing radiation is a promising but still not sufficiently studied means of restenosis prevention. To test the effects of radiation on restenosis, and especially their dependence on whether the angioplasty was followed by stent implantation or not, we performed an in-stent versus no-stent intravascular brachytherapy study in an animal model. Balloon-based, continuous and self-centering, liquid 32P sources seemed the most convenient for the purpose.
The radial dose distribution around angioplasty balloons filled with solutions of Na(2)H32PO(4) was calibrated by thermoluminescence dosimetry, both in the absence and presence of stents. The animal experiments were performed on rabbits with induced hypercholesterolemia. The balloons containing 32P were introduced into iliac artery immediately after stent implantation or after angioplasty alone. Radiation effects were evaluated postmortem by comparing thickness of various components of the artery wall.
In the presence of titanium stents (TTS), irradiation with 16 Gy dose at 1.0 mm from the balloon surface was no less effective in reducing hypertrophy in every active layer of the artery wall than without a stent.
In the animal model, IVBT basing on P(32) liquid sources was no less effective in the stented arteries than in the nonstented ones.
Cardiovascular Radiation Medicine 4(2):64-8.
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Piotr Walichiewicz,
Krzysztof Wilczek,
Barbara Petelenz, Wojciech Jacheć,
Jerzy Jochem,
Andrzej Tomasik,
Pawel Bilski,
Pawel Gaca,
Joanna Banaszczuk,
Jerzy Ihnatowicz,
Jan Wodniecki
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ABSTRACT: Response of peripheral arteries to post-dilatation intravascular brachytherapy (IVBT) using 32P liquid sources was studied in a rabbit model.
The applied sources were angioplasty balloons filled with aqueous solutions of Na2H32PO4, NaCl and iodinated contrast. Dose distribution was calibrated by thermoluminescence dosimetry. The uncertainty of in vitro determinations of the activity-dose dependence was +/- 15-30%. The animal experiments were performed on rabbits with induced hypercholesterolemia. The 32P sources were introduced into a randomly chosen (left or right) iliac artery, immediately after balloon injury. Due to the low specific activity of the applied sources, the estimated 7-49 Gy doses on the internal artery surface required 30-100 min irradiations. A symmetric, balloon-occluded but non-irradiated artery of the same animal served as control. Radiation effects were evaluated by comparing the thicknesses of various components of irradiated versus untreated artery walls of each animal.
The treatment was well tolerated by the animals. The effects of various dose ranges could be distinguished although differences in individual biological reactions were large. Only the 49 Gy dose at "zero" distance (16 Gy at 1.0 mm from the balloon surface) reduced hypertrophy in every active layer of the artery wall. The cross-sectional intimal thicknesses after 7, 12, 38 and 49 Gy doses were 0.277, 0.219, 0.357 and 0.196 mm2 respectively, versus 0.114, 0.155, 0.421 and 0.256 mm2 in controls (p < 0.05). The lowest radiation dose on the intima induced the opposite effect. Edge intimal hyperplasia was not avoided, which agrees with other reports. The edge restenosis and the variability of individual response to identical treatment conditions must be considered as limitations of the post-dilatation IVBT method.
Only application of highest irradiation doses was effective. The irradiation dose should be planned and calculated for adventitia.
CardioVascular and Interventional Radiology 27(1):42-50. · 2.09 Impact Factor
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ABSTRACT: Background: We aimed to assess the oxidant/antioxidant status within the ex vivo human coronary endarterectomy samples. Methods: To achieve this, we measured products of lipid oxidation (malondialdehyde, 7-ketocholesterol), lipids (cholesterol, cholesteryl esters) and vitamin E in endarterectomy samples. Results: Content of malondialdehyde in the plaque ranged from 0.23 to 37.36 μg/g. Unesterified cholesterol content ranged from 0.30 to 1.94 mg/g. It was 9.04±4.32% of total cholesterol. Total cholesterol content ranged from 1.73 to 23.69 mg/g. Cholesteryl palmitate content ranged from 0.57 to 19.10 mg/g, which is 11.43–60.86% of the total esters (mean±SD 40.27±18.42%). Cholesteryl oleate content ranged from 0.24 to 5.76 mg/g, being 9.97–21.81% of total esters (mean±SD 14.35±4.51%). Cholesteryl linoleate content ranged from 1.05 to 8.21 mg/g, being 17.84–45.15% of total esters (mean±SD 30.78±11.69%). Cholesteryl arachidonate content ranged from 0.51 to 4.20 mg/g, which is 7.56–22.87% of total esters (mean±SD 14.60±5.60%). The cholesteryl linoleate/cholesteryl oleate ratio (CL/CO) ranged from 1.01 to 4.33. Content of 7-ketocholesterol in the plaque ranged from 0.0 to 577.5 ng/g of wet weight. The 7-ketocholesterol/total cholesterol ratio was 0.003±0.003% (range from 0.0% to 0.008%). The 7-ketocholesterol/unesterified cholesterol ratio was 0.024±0.023% (range from 0.0% to 0.066%). The plaque content of vitamin E ranged from 0.0 to 40.9 μg/g of wet weight. Conclusion: The present study, comprising measurements of lipids, products of lipid peroxidation and vitamin E in 12 human coronary endarterectomy samples, lends the evidence for ongoing lipid peroxidation within an atherosclerotic lesion.
Clinica Chimica Acta.
