Grzegorz Karpinski

Medical University of Warsaw, Warsaw, Masovian Voivodeship, Poland

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Publications (50)89.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Assessment of stroke risk and implementation of appropriate antithrombotic therapy is an important issue in atrial fibrillation patients. Current risk scores do not take into consideration the comorbidities associated with elevated thromboembolic like obstructive sleep apnea (OSA). The aim of the study was to establish whether atrial fibrillation patients with coexisting OSA have higher stroke risk according to CHADS2 and CHA2DS2-VASc scores.
    08/2014;
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    ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia that affects the quality of life by causing deleterious health consequences, and impairing sleep quality. The severity of AF symptoms may range from very mild to the very intense which can be assessed by the European Heart Rhythm Association (EHRA) score. The aim of the study was to assess the prevalence of poor sleep quality in AF patients, in relation to the symptom severity based on the EHRA score.
    Acta cardiologica. 06/2014; 69(3):291-6.
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    ABSTRACT: Defuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and rehabilitation potential remain poorly understood.
    Kardiologia polska 05/2014; · 0.54 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are two conditions highly prevalent in the general population. OSA is known to cause hemodynamic changes, oxidative stress, and endothelial damage, and therefore promote vascular and heart remodelling which results in triggering and exacerbating AF. Coexistence of OSA and AF influences course of both diseases, and therefore should be taken into consideration in patient management strategy planning. The aim of the study was to /1/ asses the prevalence of OSA in Polish AF patients, and to /2/ describe clinical characteristics of patients with concomitant OSA and AF. We : enrolled in the : study : 289 consecutive patients hospitalized in a tertiary, high-volume Cardiology Department with a primary diagnosis of atrial fibrillation. In addition to standard examination all patients underwent an over-night sleep study to diagnose OSA, which was defined as apnea-hypopnea index (AHI) ≥ 5 per hour. After applying exclusion criteria, final analysis covered 266 patients (65.0% males, mean age 57.6 ± 10.1 years). OSA was present in 121 (45.49%) patients. Patients with OSA were older (59.6 ± 8.0 vs. 56.0 ± 11.4 years; p=0.02), had higher BMI (30.9 ± 5.4 vs. 28.7 ± 4.4 kg/m²; p < 0.01) and bigger neck (41.2 ± 3.8 vs. 39.3 ± 3.3 cm; p = 0.0001) and waist circumference (108.5 ± 13.1 vs. 107.7 ± 85.4 cm; p < 0.0001) than patients without OSA. There were no significant differences between the groups in terms of SBP, DBP or history of comorbidities (p > 0.05). OSA patients were also less likely than non-OSA patients to have paroxysmal AF (62.0% vs. 75.9%; p = 0.02). Dividing newly diagnosed OSA patients according to the disease severity showed that mild OSA (AHI ≥ 5 and < 15 per hour) to mild OSA was present in 27.82% of the study population patients, moderate OSA (AHI ≤ 15 and ≥ 30 per hour) in 13.16% patients, and severe OSA (> 30 per hour) in 4.51% patients. No significant differences in terms of comorbidities and anthropometric features were seen between mild and moderate, between moderate and severe, and between mild and severe OSA. OSA is highly prevalent in patients with AF in Polish population, and affects approximately half of this population. OSA patients are more likely to be older, have higher BMI, higher waist, and neck circumference. Persistent AF is the more common form of the arrhythmia in patients with OSA, while patients without OSA are more likely to have paroxysmal AF.
    Kardiologia polska 03/2014; · 0.54 Impact Factor
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    ABSTRACT: Sleep duration and sleep quality affect patients' general condition and self-reported health status. The aims of this study were: (1) to describe the clinical characteristic of ST-elevation myocardial infarction patients who sleep too little or too much; and (2) to determine whether sleep duration is independently associated with higher risk of all-cause mortality. We enrolled into the study 407 consecutive patients admitted with diagnosis of ST-elevation myocardial infarction (STEMI). All patients were asked for sleep duration in the first three months after being discharged from the hospital. According to the sleep duration, we divided patients into three groups: A) the reference category defined as 6-8 sleep hours, B) short sleep with <6 h and C) long sleep with >8 h. The final analysis covered 379 patients [271 males; mean age 59.4±10.61]. 36 (9.5%) patients slept less than 6 hours, 26 (6.9%) slept more than 8 hours per night. The all-cause 3-year mortality was 1.9% in the reference category, 13.9% in patients who slept less than 6 hours, and 30.8% in patients who slept more than 8 hours per night (p<0.0001). In the multiple logistic regression analysis, short (odds ratio 10.2, 95% CI 2.1-50;p=0.004) and long sleep duration (odds ratio 33.3, 95% CI 6.8-163.4; p<0.001) were strong and independent predictors of all-cause mortality. Too short and especially too long duration of sleep in first months after myocardial infarction are strong, independent predictors of all-cause mortality.
    Kardiologia polska 02/2014; · 0.54 Impact Factor
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    ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is a cardiovascular risk factor associated with clinical complications like hypertension, ischaemic heart disease or thrombosis. The aim of this study was to develop a new scoring system, based on objective clinical and echocardiographic parameters.
    01/2014;
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    ABSTRACT: We report a case of a 52-year-old human immunodeficiency virus (HIV)-infected male patient receiving combined antiretroviral therapy (cART), who presented with acute ST-elevation myocardial infarction (STEMI). He was properly treated (e.g., prescribed anti-coagulation drugs: aspirin, clopidogrel, enoxaparin) and discharged. After 1.5 months, another STEMI related with in-stent thrombosis took place. The cART scheme was altered, resulting in no further cardiac events in the follow-up period, with undetectable levels of HIV ribonucleic acid. This case highlights the association between HIV infection and the specific drugs of cART, and the risk of cardiovascular disease development.
    Korean Circulation Journal 01/2014; 44(1):42-4.
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    ABSTRACT: Cardiovascular disease are the leading cause of death worldwide. One of the most important diseases in this group is myocardial infarction. According to the Universal Definition developed by the European Society of Cardiology (ESC) myocardial infarction is divided into five main types basing on its cause. Type 2 myocardial infarction is secondary to ischemia due to either increased demand or decreased supply of oxygen (in example due to coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension). The aim of the study was (1) to assess the occurrence and etiology of type 2 acute myocardial infarction (AMI), and (2) to describe the clinical characteristics and prognosis of study patients. Into the retrospective study we enrolled 2882 patients in Cardiology Department with an initial diagnosis of AMI between 2009 and 2012. Diagnosis of AMI was made basing on ESC criteria. In all patient coronary angiography was performed in order to exclude hemodynamically significant coronary lesions. Among 2882 patients hospitalized in the described time period, 58 (2%) patients were diagnosed with type 2 AMI. Mean age of the study group was 67.3±13.2 years; and the majority of the study group 60.3% were women. Out of them 23 (39.6%) patients experienced AMI due to coronary artery spasm, 15 (25.9%) due to arrhythmias, 11 (19%) due to severe anaemia and 9 (15.5%) due to hypertension, without significant coronary artery disease. Majority of patients - 42 (72.4%) was diagnosed as non-ST-segment elevation myocardial infarction, while 14 (24.1%) as ST-segment elevation myocardial infarction, and 2 (3.5%) as AMI in the presence of ventricular paced rhythm. History of classical cardiovascular risk factors including hypertension, diabetes, dyslipidemia, family history of heart diseases, and smoking was reported in 42 (72.4%), 14 (24.1%), 23 (39.7%), 24 (41.4%), 16 (27.6%) cases, respectively. All-cause, 30-day mortality rate was 5.2%, and 6-month was 6.9%. Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation myocardial infarction. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading cause of AMI was coronary artery spasm.
    Kardiologia polska 10/2013; · 0.54 Impact Factor
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    ABSTRACT: We report a case of a 54-year-old obese, loudly snoring male, who presented to the hospital with typical ischemic chest pain of early morning onset, and high blood pressure values. A standard 12-lead ECG performed on admission showed ST-segment elevation in leads II, III, aVF, V1 and ST-segment depression in leads I, aVL, V2 to V4, but coronary angiography revealed no evidence of plaque rupture or erosion in an epicardial coronary vessel. Performed polysomnography confirmed severe obstructive sleep apnea (OSA). According to the universal definition of myocardial infarction patient was diagnosed with acute ST-segment elevation myocardial infarction type 2, caused probably by sudden blood pressure rise secondary to apnea episode in the course of OSA. Patient was treated with continuous positive airway pressure device and suffered no further adverse cardiovascular event during 12 months of follow-up. The case highlights importance of further investigation of novel risk factors such as OSA, and possibly listing it as one of the causes of acute myocardial infarction type 2.
    Cor et vasa 10/2013; 55(5):e449–e452.
  • The American journal of emergency medicine 09/2013; · 1.54 Impact Factor
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    ABSTRACT: To compare the long-term prediction value of the six risk scores in a 7-year follow-up of acute coronary syndrome (ACS) patients. We followed 906 patients diagnosed with ACS for 7 years prospectively. Following risk scores (RS) were calculated: TIMI STEMI, TIMI NSTEMI, GRACE, SIMPLE, ZWOLLE and BANACH. Based on the survival data the prediction value for each RS was calculated with receiver operating characteristics (ROC) curve analysis and presented as area under curve (AUC). The 7-year survival was 71%. The RS showed diverse long-term prediction values and AUC. The best estimation was demonstrated by the TIMI STEMI (0.779 [95% CI 0.743 to 0.812]), GRACE RS (0.766 [95% CI 0.737 to 0.794]) and BANACH RS (0.743 [95% CI 0.713 to 0.771]). Other scores presented were SIMPLE (0.714 [95% CI 0.683 to 0.743], TIMI NSTEMI (0.635 [95% CI 0.580 to 0.688]) and ZWOLLE (0.739 [95% CI 0.697 to 0.779]. The prediction values of currently recommended RS are good for long-term perspective (7-year). RS with high usability, such as BANACH RS demonstrates accuracy similar to the more advanced RS.
    Kardiologia polska 08/2013; · 0.54 Impact Factor
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    ABSTRACT: During cardiac arrest and after cardiopulmonary resuscitation, activation of blood coagulation occurs, with a lack of adequate endogenous fibrinolysis. The aim of the present study was to determine whether the serum D-dimer concentration on admission is an independent predictor of all-cause mortality in patients with out-of-hospital cardiac arrest. We enrolled 182 consecutive patients (122 men, mean age 64.3 ± 15 years), who had presented to the emergency department from January 2007 to July 2012 because of out-of-hospital cardiac arrest. Information about the initial arrest rhythm, biochemical parameters, including the D-dimer concentration on admission, neurologic outcomes, and 30-day all-cause mortality were retrospectively collected. Of the 182 patients, 79 (43.4%) had died. The patients who died had had lower systolic (100 ± 39.6 vs 120.5 ± 26.9 mm Hg; p = 0.0004) and diastolic (58.3 ± 24.1 vs 74 ± 16.3 mm Hg; p <0.0001) blood pressure on admission. The deceased patients more often had had a history of myocardial infarction (32.9% vs 25.2%; p = 0.04) and less often had had an initial shockable rhythm (41.8% vs 60.2%; p = 0.02). The patients who died had had a significantly higher mean D-dimer concentration (9,113.6 ± 5,979.2 vs 6,121.6 ± 4,597.5 μg/L; p = 0.005) compared with patients who stayed alive. On multivariate logistic regression analysis, an on-admission D-dimer concentration >5,205 μg/L (odds ratio 5.7, 95% confidence interval 1.22 to 26.69) and hemoglobin concentration (odds ratio 1.66, 95% confidence interval 1.13 to 2.43) were strong and independent predictors of all-cause mortality. In conclusion, patients with a higher D-dimer concentration on admission had a poorer prognosis. The D-dimer concentration was an independent predictor of all-cause mortality.
    The American journal of cardiology 05/2013; · 3.58 Impact Factor
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    ABSTRACT: We report a case of a 61-year-old male patient who presented with reduced exercise capacity, dyspnea, lower limbs oedema,irregular heart rhythm, loud, irregular snoring, history of poorly controlled hypertension, nocturnal hypertension spikes, andmorning headaches. Patient underwent ECG Holter monitoring and polygraphy, which revealed severe obstructive sleepapnea. In ECG Holter monitoring atrial fibrillation with pauses to 6.5 s were observed. Patient was referred for continuouspositive airway pressure (CPAP) treatment. Three-months of CPAP therapy resulted in significant decrease in apnea-hypopneaindex (31.6/h vs. 5.1/h) and better control of hypertension and heart failure. CPAP treatment allowed us to reduce patient's cardiovascular risk. Cardiologist should routinely screen and evaluate patients for sleep disordered breathing, especially when patients are obese, have hypertension and/or arrhythmias.
    Kardiologia polska 01/2013; 71(8):845-7. · 0.54 Impact Factor
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    ABSTRACT: A 37 year-old male patient was admitted to the intensive care unit after an out-of-hospital cardiac arrest due to ventricular fibrillation in a course of ST-segment elevation acute coronary syndrome. On admission, the patient was unconscious with a Glasgow Coma Scale (GCS) score of 5. A percutaneous coronary intervention and mild therapeutic hypothermia (HT), defined as maintaining body temperature between 32°C and 34°C, were performed. During HT on ECG, we observed Osborn waves, which resolved spontaneously after re-warming. After five days of recovery, the patient scored 15 on GCS and did not show any neurological deficits.
    Kardiologia polska 01/2013; 71(1):88-90. · 0.54 Impact Factor
  • Kardiologia polska 01/2013; 71(7):752-6. · 0.54 Impact Factor
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    ABSTRACT: We report the case of a 34-year-old male patient who presented with generalized weakness, poorly controlled hypertension, nocturnal hypertension spikes, and morning headaches. The history of resistant hypertension, obesity, enlarged neck size, and loud irregular snoring strongly suggested obstructive sleep apnea (OSA). To exclude other possible causes of resistant hypertension, the patient underwent an abdominal ultrasound examination, which revealed a lesion in the left adrenal gland area. A pheochromocytoma was successfully removed via laparoscopic adrenalectomy, and both his hypertension and OSA responded dramatically. This case highlights the importance of excluding all causes of resistant hypertension regardless of the initial diagnosis.
    The Canadian journal of cardiology 01/2012; 28(3):397.e5-7. · 3.12 Impact Factor
  • Journal of Emergency Medicine 12/2011; · 1.33 Impact Factor
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    ABSTRACT: A limited number of studies comparing the main risk scores (RS) for acute coronary syndromes (ACS) have been conducted and there is a limited number of long-term observations of unselected patient cohorts evaluated with the various RS. The aim of this study was to validate 5 RS (TIMI STEMI RS, TIMI NSTEMI/UA RS, GRACE RS, SIMPLE RS and ZWOLLE RS) in a Polish population and to develop a new RS that would specifically predict 1-year mortality in the unselected ACS patient cohort. Single-center ACS registry analysis with 1-year follow-up of 931 patients and prospective comparison of 5 RS was conducted. Creation of an RS was attempted. Risk factors were evaluated in a multivariate logistic regression model. The predictive value of the model was assessed with evaluation of the area under curve (AUC) in receiver-operating characteristic analysis. Twelve independent factors influencing 1-year mortality were identified and of them, clerking, physical findings on admission, first ECG and myocardial necrosis markers demonstrated sufficiently high predictive value. All 5 RS were successfully validated in the target registry and although they all displayed high predictive value, the TIMI RS STEMI (AUC = 0.84) and GRACE RS (AUC = 0.84) proved superior. The developed Banach score offers both high goodness-of-fit and predictive value and may be used irrespective of ACS type.
    Circulation Journal 11/2010; 75(1):167-73. · 3.58 Impact Factor
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    ABSTRACT: Takotsubo cardiomyopathy (TTC) is a rare transient cardiomyopathy mimicking acute coronary syndrome (ACS). The aim of the study was to retrospectively analyze the clinical course, treatment strategies, and follow-up of patients with TTC. Among all patients hospitalized in the department between January 2005 and January 2010, we identified a group of patients who were fulfilling the modified Mayo Clinic criteria for the diagnosis of TTC. Clinical presentation, hospital course, and clinical outcomes were analyzed. A total of 31 patients with TTC were included into the study; women comprised 93.5% of the study population. The most common symptoms included chest pain and dyspnea caused by emotional or physical stress. Cardiogenic shock was present in 2 subjects and life-threatening ventricular arrhythmias in 3 other patients. Twenty-four patients had ST-segment elevation on the electrocardiogram. A mean left ventricular ejection fraction was 42 +/-8.6% during contractility abnormalities, and it increased to 58 +/-7.9% during recovery. Troponin I was positive in 30 cases with a mean peak level of 2.7 +/-5.1 ng/ml. Follow-up data were available in 23 patients and a mean follow-up was 955 +/-502.8 days. We did not observe a recurrence of TTC. TTC is observed mainly in postmenopausal women. Clinical presentation of TTC is almost indistinguishable from ACS, but its course is milder and the outcomes are better.
    Polskie archiwum medycyny wewnȩtrznej 06/2010; 120(6):231-6. · 2.05 Impact Factor
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    ABSTRACT: We present the case of a 45-year-old patient readmitted to Central University Hospital at 3 a.m. for acute retrosternal chest pain associated with ST-segment elevation in lead I, aVL, V1-V6 in standard 12-lead ECG performed on admission in emergency department. Coronary angiography revealed late in-stent thrombosis in left anterior descending artery. According to the new universal definition of myocardial infarction patient was finally recognized acute ST-segment elevation myocardial infarction type 4b with additional diagnosis of severe obstructive sleep apnea and overweight.
    Sleep And Breathing 05/2010; 15(3):607-9. · 2.26 Impact Factor