[Show abstract][Hide abstract] ABSTRACT: Background and Purposes: Several circulating biomarkers have been implicated in carotid atherosclerotic plaque rupture and thrombosis; however, their clinical utility remains unknown. The aim of this study was to determine the role of a large biomarker panel in the discrimination of symptomatic (S) vs. asymptomatic (A/S) subjects in a contemporary population with carotid artery stenosis (CS). MethodszzProspective sampling of circulating cytokines and blood lipids was performed in 300 unselected, consecutive patients with ≥50% CS, as assessed by duplex ultrasound (age 47-83 years; 110 with A/S and 190 with S) who were referred for potential CS revascularization. ResultszzCS severity and pharmacotherapy did not differ between the A/S and S patients. The median values of total cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a) did not differ, but high-density lipoprotein (HDL) cholesterol was significantly higher (p<0.001) and triglycerides were lower (p=0.03) in the A/S-CS group than in the S-CS group. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein were higher (p=0.04 and p=0.07, respectively) in the S-CS group. Circulating visfatin, soluble CD 40 receptor ligand, soluble vascular cell adhesion molecule, leptin, adiponectin, IL-1β, IL-8, IL-18, monocyte chemoattractant protein-1, myeloperoxidase, matrix metalloproteinases-8, -9, and -10, and fibrinogen were similar, but tissue inhibitor of matrix metalloproteinases-1 (TIMP) was reduced in S-CS compared to A/S-CS (p=0.02). Nevertheless, incorporation of TIMP and IL-6 did not improve the HDL-cholesterol receiver operating characteristics for S-CS status prediction. S-CS status was unrelated to angiographic stenosis severity or plaque burden, as assessed by intravascular ultrasound (p=0.16 and p=0.67, respectively). Multivariate logistic regression analysis revealed low HDL-cholesterol to be the only independent predictor of CS symptoms, with an odds ratio of 1.81 (95% confidence interval=1.15-2.84, p=0.01) for HDL <1.00 mmol/L (first quartile) vs. >1.37 (third quartile). In S-CS, osteoprotegerin and lipoprotein-associated phospholipase A2 (Lp-PLA2) were elevated in those with recent vs. remote symptoms (p=0.01 and p=0.02, respectively). ConclusionszzIn an all-comer CS population on contemporary pharmacotherapy, low HDLcholesterol (but not other previously implicated or several novel circulating biomarkers) is an independent predictor of S-CS status. In addition, an increase in circulating osteoprotegerin and Lp-PLA2 may transiently indicate S transformation of the carotid atherosclerotic plaque.
Journal of Clinical Neurology 07/2013; 9:165-175. · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The very high cardiovascular mortality and morbidity in hemodialyzed patients (HD) is strongly associated with cardiovascular calcification. The aim of the study was to find the predictors of mortality in HD patients during 5-years observation period. The study group was composed of 64 patients (35 F, 29 M) aged 25-75 years (mean 48.9) hemodialyzed three times a week for 12-275 months (mean 77.8). The levels of hemoglobin, total protein, albumin, Ca, P, Ca x P, iPTH, cholesterol, triglycerides, fibrinogen, insulin, homocysteine, leptin, procalcitonin, CRP, IL-6, TGF-beta, PDGF were assessed and all patients underwent Calcium Score (CS) of coronary arteries (CACS) calculation using MSCT and B-mode ultrasound of carotid arteries for intima-media thickness (CCA-IMT), as well as echocardiographic assessment with LVMI calculation and heart valves evaluation at the start of observation. The self-elaborated Cumulative Calcification Index (CCl) was calculated as a sum of CACS Index according to Rumberger et al. (CS<10-0, 10<CS<100-1, 100<CS<400 - 2, CS>400 - 3 points); number of calcified plaques in carotid arteries (0-0, 1 - 1, 2 - 2, 3 and more - 3 points) and the number of calcified heart valves. At the start of the study the median value of CCl was 4 and interquartile range 4. Only 2 (3%) patients were free of any type of cardiovascular calcification (CCl =0), 15 (23%) patients had minimal calcification (CCl 1 to 2 points), 33 (52%) average (2 - 6 points) and 14 (22%) patients had severe calcification (CCl>6). 21 (32,8%) patients died during observation period. Patients who died were older (56.9 vs. 45.3 yrs.) and had higher CS at the start (1275 vs. 356), higher CCA-IMT (0.948 vs. 0.687 mm) and CCl (6.15 vs. 3.63) values. Those patients had also higher CRP (0.645 vs. 0.245 mg/dl) and IL-6 (10.16 vs. 4.15 pg/ml) levels (p<0.05). LVMI and mean: hemoglobin, total protein, albumin, Ca, P, Ca x P, iPTH, cholesterol, triglycerides, fibrinogen, insulin, homocysteine, leptin, procalcitonin, TGF-beta as well as PDGF levels did not differ between the groups. In logistic regression model (p<0.00002), among tested parameters only CCl was an independent and statistically significant factor of mortality with OR=1.82 per every point of CCl (p<0.0003). Cardiovascular calcification expressed as CCl confirmed to be a strong predictor of mortality in HD patients.
[Show abstract][Hide abstract] ABSTRACT: Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5 ± 9.7 years, 36 men) with chronic IMR (regurgitant volume, RV > 20 ml; >6 months after MI) underwent transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging. Anterior and posterior MLA, determined by echocardiography, were correlated with indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR. The anterior and posterior MLA was 25.41 ± 4.28 and 38.37 ± 8.89° (mean ± SD). In 5 patients (11.9%) the posterior MLA was ≥45°. There was a significant correlation between anterior MLA and RV (r = 0.74, P = 0.01). For patients with RV > 30 ml this correlation was stronger (r = 0.97, P = 0.005) and, in addition, there was a correlation between the RV and posterior MLA (r = 0.90, P = 0.037), between tenting area and posterior MLA (r = 0.90, P = 0.04), and between tenting area and anterior MLA (r = 0.82, P = 0.08). With regard to LV remodeling parameters, there was weaker but significant correlation between posterior MLA and LV end-diastolic volume index (r = 0.35, P = 0.031), LV end-systolic volume index (r = 0.37, P = 0.021), stroke volume (r = 0.35, P = 0.03), sphericity index (r = 0.33, P = 0.041). Anterior MLA correlated with wall motion score index (r = 0.41, P = 0.019). Besides, there was a correlation between posterior MLA and left atrial volume (r = 0.41, P = 0.012). Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR.
The international journal of cardiovascular imaging 01/2011; 28(1):59-67. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Antiplatelet 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.
Kardiologia polska 01/2011; 69(9):907-12. · 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: Growing evidence indicates that statins may reduce thromboxane A(2) synthesis and thrombin generation. We investigated the relationships between thromboxane production, thrombin generation, and oxidative stress in patients receiving aspirin before and after statin administration.
An open-label study was conducted in 112 men, aged 54.4 ± 7.3 years, at an increased cardiovascular risk receiving aspirin (75 mg/d). Prior to and following a 3-month simvastatin treatment (40 mg/d), we evaluated circulating thromboxane B(2) (TXB(2)), inflammatory markers, 8-isoprostane, and prothrombin fragment 1.2 (F1.2), a marker of thrombin generation, which was also measured in blood collected every 60s at the site of standardized skin incisions.
Subjects (n=28) with pretreatment TXB(2) concentrations in the highest quartile ("aspirin-resistant patients") were more frequently current smokers and had elevated C-reactive protein (CRP), interleukin-6, 8-isoprostane, shorter bleeding time, and increased F1.2 production in a model of microvascular injury, when compared with the 3 remaining quartiles (all, p<0.001). Simvastatin decreased serum TXB(2) in the whole group (by 20%, p=0.0008). Patients in the highest quartile of the baseline TXB(2) had still higher posttreatment TXB(2), CRP, interleukin-6, and F1.2 formation following injury (all, p<0.001). Simvastatin-induced change in TXB(2) correlated with the magnitude of changes in maximum levels and the velocity of F1.2 formation (all p<0.001) but not with changes in inflammatory markers or lipid profile.
The study shows that statins significantly reduce platelet TXA(2) formation in patients taking low-dose aspirin and this effect is associated with attenuated thrombin formation in response to vascular injury.
International journal of cardiology 10/2010; 154(1):59-64. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to assess the role of myocardial contrast echocardiography (MCE) as a predictor of cardiac events and death in patients with acute myocardial infarction (AMI).
Eighty-six patients underwent primary percutaneous coronary angioplasty for AMI. Segmental perfusion was estimated by MCE in real time at mean 5 days after PCI using low MI (0.3) after 0.3-0.5 ml bolus injection of intravenous Optison. MCE was scored semiquantitatively as: (1) normal perfusion (homogenous contrast effect), (2) partial perfusion (patchy myocardial contrast enhancement), (3) lack of perfusion (no visible contrast effect). A contrast score index (CSI) was calculated as the sum of MCE scores in each segment divided by the total number of segments. The patients were followed up for cardiac events and death.
A CSI of >1.68 was taken to be a predictor of cardiac events and death. Death occurred only in patients with CSI >1.68. Patients with CSI >1.68 had a significantly (P = 0.03) higher incidence of cardiac death or cardiac events (75%) compared to those with CSI <1.68 (27%). The absence of residual perfusion within the infarct zone was an independent predictor of death and cardiac events (P = 0.02).
The absence of residual myocardial viability in the infarct zone supplied by an infarct-related artery is a powerful predictor of cardiac events in patients after AMI.
[Show abstract][Hide abstract] ABSTRACT: To report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion.
Four patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The "tailored" CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful.
Due to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.
Journal of Endovascular Therapy 12/2009; 16(6):744-51. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Both in the European and Polish guidelines, the highest priority for preventive cardiology was given to patients with established coronary artery disease (CAD). The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was introduced in 1996 to assess and improve the quality of clinical care in secondary prevention. Departments of cardiology of five participating hospitals serving the area of the city of Kraków and surrounding districts (former Kraków Voivodship) inhabited by a population of 1 200 000 took part in the surveys. In 1999/2000 and 2006/2007 the same hospitals joined the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) II and III surveys. The goal of the EUROASPIRE surveys was to assess to what extent the recommendations of the Joint Task Force of International Scientific Societies were implemented into clinical practice.
To compare the quality of secondary prevention in the post-discharge period in Kraków in 1997/1998, 1999/2000 and 2006/2007.
Consecutive patients hospitalised from 1 July 1996 to 31 September 1997 (first survey), from 1 March 1998 to 30 March 1999 (second survey), and from 1 April 2005 to 31 July 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of 71 years were identified and then followed up, interviewed and examined 6-18 months after discharge.
The number of patients who participated in the follow-up examinations was 418 (78.0%) in the first survey, 427 (82.9%) in the second and 427 (79.1%) in the third survey. The use of cardioprotective medication increased significantly: antiplatelets from 76.1% (1997/1998) to 86.9% (1999/2000) and 90.1% (2006/2007), beta-blockers from 59.1% (1997/1998) to 63.9% (1999/2000) and 87.5% (2006/2007), and ACE inhibitors/sartans from 45.9% (1997/1998) to 79.0% (2006/2007). The proportion of patients taking lipid lowering agents increased from 34.0% (1997/1998) to 41.9% (1999/2000) and 86.8% (2006/2007). Simultaneously, a significant improvement in the control of hyperlipidemia could be noted. In 2006/07, over 60% had a serum LDL cholesterol < 2.5 mmol/l. No significant change was found in the proportion of subjects with well-controlled hypertension or diabetes. In 2006/2007, elevated blood pressure was found in 46.6% of participants and glucose > 7 mmol/l in 13.4%. There was no significant change in smoking rates (16.3 vs. 15.9 vs. 19.2%). The proportion of obese patients increased reaching 33.9% in 2006/2007.
The implementation of CAD prevention guidelines into clinical practice over the decade from 1997/1998 to 2006/2007 changed significantly. The use of cardioprotective drugs increased largely but among risk factors a significant improvement could be found only in the case of hypercholesterolemia. No improvement in the control of hypertension and diabetes, no change in smoking rates and increasing prevalence of obesity suggest insufficient lifestyle modifications in CAD patients.
Kardiologia polska 12/2009; 67(12):1353-9. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypercoagulable state occurs in patients with acute vascular events. We wondered whether clot structure/function is altered in acute ischemic stroke (AIS), like in acute myocardial infarction.
In 45 consecutive patients with AIS (24M, 21F), aged 67.4+/-10.9 years, and 45 healthy controls matched for age and sex, we investigated plasma fibrin clot structure/function by permeation, turbidity, and efficiency of fibrinolysis.
Compared to controls, AIS patients produced clots that had 30.5% less porous network (p<0.0001), were less susceptible to fibrinolysis (10.8% longer lysis time, p=0.001), were 20.5% more compact (p<0.0001), had 17.1% higher clot mass (p<0.0001), and showed increased (by 10.2%) overall fiber thickness (p<0.0001) with 8% shorter lag phase of fibrin formation (p=0.0002). Maximum rate of D-dimer release from clots was similar. Multiple regression analyses for all subjects (n=90) showed that being a stroke patient (p<0.0001), fibrinogen (p<0.0001) and lipoprotein(a) (p=0.0075) were independent predictors of clot permeability (model R2 0.79). Only fibrinogen (p<0.0001) and lipoprotein(a) (p=0.0026) predicted lysis time. All other fibrin parameters were predicted only by being a stroke patient. Clot compaction was associated with neurological deficit on admission (r=-0.81; p<0.0001) and at discharge (r=-0.69; p<0.0001). Patients with 0 or 1 point in the modified Rankin scale (n=19) had 13.3% higher clot permeability compared to the remainder (p=0.02).
This study is the first to show that AIS is associated with unfavorably altered fibrin clot properties that might correlate with neurological deficit.
Thrombosis Research 11/2009; 125(4):357-61. · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of blood coagulation in the pathogenesis of aortic stenosis (AS) is unknown. Recently, tissue factor (TF) expression in stenotic aortic valves has been reported in animal model.
The aim of the study was to investigate TF expression in valve leaflets obtained from AS patients and to determine its associations with circulating coagulation markers and echocardiographic variables.
We studied 20 patients (10 men, 10 women) with dominant AS (age 62.9 +/-9.6, years, mean gradient 43.62 +/-14.62 mmHg), and 20 well-matched patients with dominant aortic insufficiency (AI) undergoing elective aortic valve replacement. Immunofluorescence was measured on decalcified leaflets using antibodies against human TF and macrophages. Prothrombin fragment 1+2 (F1+2) and circulating TF were determined in plasma prior to surgery.
AS valves were characterized by an increased (all, p <0.001) percentage of TF-positive (24.6%) and macrophage-containing (27.3%) areas detected mainly on the aortic side of the leaflets, compared with AI valves (6.3% and 7.4%, respectively). Patients with AS had elevated F1+2 (262.1 +/-27.8 pmol/l, p <0.001) and plasma TF (median 131.8, interquartile range [91.42-310.56] pg/ml, p = 0.018) compared with AI subjects (136.1 +/-11.9 pmol/l, 65.38 [49.51-87.81] pg/ml, respectively). Percentage of TF-positive areas correlated with plasma TF (r = 0.68, p <0.0001), but not with F1+2. Maximum transvalvular gradient >75 mmHg, but not the aortic valve area, showed associations with percentage of TF-positive areas (r = 0.88, p = 0.0039).
This study is the first full-length report demonstrating the presence of TF associated with macrophage infiltration in human aortic valve leaflets in AS patients.
Polskie archiwum medycyny wewnȩtrznej 10/2009; 119(10):636-43. · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Both in the European and Polish guidelines the highest priority for preventive cardiology was given to patients with established cardiovascular disease. The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was initiated in 1996. The main goal of the program was to assess and improve the quality of clinical care in the secondary prevention of ischaemic heart disease. Later, the same centres joined the EUROASPIRE (European Action on Secondary and Primary Prevention Intervention to Reduce Events) II and III surveys.
To compare the quality of secondary prevention in Krakow cardiac departments in 1996/1997, 1998/1999 and 2005/2006.
Five hospitals serving the area of the city of Krakow and surrounding districts (former Krakow Voivodship), inhabited by 1,200,000 persons, took part in the surveys. Consecutive patients hospitalised from July 1, 1996 to September 31, 1997 (first survey), from March 1, 1998 to March 30, 1999 (second survey), and from April 1, 2005 to July 31, 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of <71 years were recruited and included to the present analysis. All medical records were reviewed by trained reviewers using standardised data collection forms.
Medical records of 536 patients treated in 1996/1997, 515 treated 1998/1999, and 540 treated in 2005/2006 were reviewed and analysed. Proportions of medical records with available information on risk factors prior to hospitalisation as well as proportions of medical records with available information on blood pressure (by 10%, p < 0.05) and lipids (by over 30%, p < 0.05) measurements during the first 24 h of hospitalisation as well as on weight and height measurements (by 16%, p < 0.05) increased significantly from 1996/1997 to 2005/2006. Antiplatelets prescription rate at discharge increased from 87% to 97% (p < 0.05), prescription rate for beta-blockers increased from 66% to 91% (p < 0.05), ACE inhibitors/sartans from 50% to 89% (p < 0.05), and lipid lowering drugs from 27% to 96% (p < 0.05) between 1996/1997 and 2005/2006, respectively.
The implementation of secondary prevention guidelines into clinical practice in the Krakow cardiac departments improved in 2005/2006 as compared to 1996/1997 and 1998/1999. Our results suggest that recent decade brought significant improvement in the approach to secondary prevention of ischaemic heart disease in hospital practice.
Kardiologia polska 08/2009; 67(8A):970-7. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We tested the hypothesis that fibrin structure/function is unfavorably altered in patients after idiopathic venous thromboembolism (VTE) and their relatives. Ex vivo plasma fibrin clot permeability, turbidimetry, and efficiency of fibrinolysis were investigated in 100 patients with first-ever VTE, including 34 with pulmonary embolism (PE), 100 first-degree relatives, and 100 asymptomatic controls with no history of thrombotic events. Known thrombophilia, cancer, trauma, and surgery were exclusion criteria. VTE patients and their relatives were characterized by lower clot permeability (P < .001), lower compaction (P < .001), higher maximum clot absorbancy (P < .001), and prolonged clot lysis time (P < .001) than controls, with more pronounced abnormalities, except maximum clot absorbance, in the patients versus relatives (all P < .01). Fibrin clots obtained for PE patients were more permeable, less compact, and were lysed more efficiently compared with deep-vein thrombosis patients (all P < .05) with no differences in their relatives. Being VTE relative, fibrinogen, and C-reactive protein were independent predictors of clot permeability and fibrinolysis time in combined analysis of controls and relatives. We conclude that altered fibrin clot features are associated with idiopathic VTE with a different profile of fibrin variables in PE. Similar features can be detected in VTE relatives. Fibrin properties might represent novel risk factors for thrombosis.
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular diseases are the number one killer in the developed countries, accounting for approximately half of all deaths, with the leading causes being myocardial infarction and ischaemic stroke. In line with the ageing population, the prevalence of coronary artery disease (CAD), lower extremity peripheral arterial disease (PAD), supra-aortic arterial disease (SAD) and renal stenosis (RAS) is increasing. Polyvascular atherosclerosis (PVA) coexisting in several territories has an adverse effect on cardiovascular morbidity and mortality.
To determine prevalence, coexistence and predictors of significant PAD, SAD and RAS in patients with suspected CAD.
Based on angiography, the frequency of coexisting CAD, SAD, PAD and RAS (stenosis > or =50%) was determined in 687 (487 male) consecutive patients, aged 63.5 +/- 9.1 years, referred for coronary angiography.
Significant CAD was found in 545 (79.3%) patients (1-vessel in 164; 2-vessel in 157; 3-vessel in 224). SAD, RAS and PAD were found in 136 (19.8%), 55 (8%), and 103 (15%) patients, respectively. Of the 545 patients with confirmed CAD, 346 (63.5%) had stenoses limited to coronary arteries. 2-, 3- and 4-level PVA was found in 130 (23.8%), 61 (11.2%) and 8 (1.5%) patients, respectively. Of the 142 patients without CAD, 127 (89.4%) had no significant stenoses elsewhere, 12 (8.5%) had 1 extracoronary territory and 3 (2.1%) had 2-territory involvement. Backward stepwise binary logistic regression analysis showed the following independent predictors of at least 2-level PVA: 2- and 3-vessel CAD (p < 0.001), hyperlipidaemia (p = 0.067), smoking (p < 0.001), creatinine level > or = 1.3 ml/dl (p < 0.001), lower extremities claudication (p < 0.001) and female gender (p = 0.003). The relative risk of having at least 2-territory PVA was 15.7-fold higher in patients with claudication, 2.1-fold in patients with multivessel CAD, 2.8-fold for serum creatinine level > 1.3 mg/dl; and 1.9-fold, 2.4-fold and 2-fold in patients with hyperlipidaemia, smokers and women, respectively. Conclusions: Significant atherosclerosis in extracoronary arterial territories is present in 36% of patients with documented CAD. With advancing PVA, accumulation of atherosclerosis risk factors, previous atherothrombotic events and more severe CAD is observed.
Kardiologia polska 08/2009; 67(8A):978-84. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In patients with coronary artery disease (CAD), the presence of atherosclerotic lesions in other vascular beds is associated with a markedly worse prognosis.
To determine the prevalence and predictors of extracranial supra-aortic artery atherosclerotic disease (SAD) in patients with suspected CAD.
Supra-aortic artery angiography was performed in 379 consecutive patients aged 64.2 +/- 8.8 years (231 male) referred for coronary angiography. Clinical and laboratory data (total cholesterol, LDL, HDL cholesterol, hs-CRP, creatinine level) and left ventricular ejection fraction were analysed.
Significant stenosis (> or =50% by quantitative angiography) within at least one main branch of the coronary arteries was found in 314 (82.8%) patients, including 87 (27.7%), 96 (30.6%) and 131 (41.7%) with 1-vessel, 2-vessel, and 3-vessel CAD, respectively. Among all 379 patients, stenosis > or =50% of the carotid artery was documented in 9.5%, vertebral in 13.7%, and subclavian in 7.4% of patients. We found 130 stenoses > or =50% within the supra-aortic arteries in 90 patients (23.7% of the whole study group, and 28.7% of CAD patients), including 42 internal carotid artery stenoses in 36 patients, 58 vertebral artery stenoses in 52, and 30 subclavian stenoses in 28 patients. In 24 (6.3%) patients more than one SAD was present. The SAD > or =50% was found in 8 (12.3%) patients without significant CAD, in 22 (25.3%), 17 (17.7%) and 43 (32.8%) with 1-, 2- and 3-vessel CAD, respectively (p = 0.001). Independent predictors of SAD > or =50% identified by multivariate analysis were: previous neurological ischaemic event (p = 0.001), CAD (p = 0.015), creatinine level (p = 0.031), male gender (p = 0.001), claudication (p < 0.001) and low HDL cholesterol (p = 0.033). The following independent predictors of vertebral and/or subclavian artery stenosis > 50% were identified: CAD severity (p = 0.002), creatinine level (p = 0.024), male gender (p = 0.013), claudication (p < 0.001) and low HDL cholesterol level (p = 0.059).
In a large patient sample, we have found that significant supra-aortic atherosclerosis is present in a quater of patients with suspected CAD. Importantly, SAD prevalence increases with CAD severity. Previous neurological ischaemic event, CAD, creatinine level, male gender, claudication and hyperlipidaemia were identified as independent predictors of SAD > or =50%.
Kardiologia polska 08/2009; 67(8A):985-91. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Contrast-enhanced magnetic resonance imaging (CE-MRI) can identify myocardial scarring following acute myocardial infarction (AMI).
To compare myocardial contrast echocardiography (MCE) and CE-MRI in detection of resting perfusion defect in patients with acute myocardial infarction.
Twenty four patients (21 men, 3 women, mean age 58.7 +/- 11.4 years) underwent primary percutaneous coronary angioplasty (PCI) for anterior AMI. All patients underwent MCE: segmental perfusion was estimated in real time before and immediately after PCI and on third day after PCI, using low mechanical index (0.3) after 0.3-0.5 ml bolus injections of intravenous OptisonTM. The MCE was scored semiquantitatively as: 1--homogenous contrast enhancement, 2--patchy contrast enhancement, 3--no contrast (non-viable myocardium). All patients underwent CE-MRI on a 1.5 T scanner (SONATA, Siemens) on the third day after PCI. Acquisition of short axis slices was performed before and 20 min after injection of Gd-DPTA (0.15 mmol/kg) with an inversion recovery TurboFLASH sequence (TE 1.1 ms, TR 700 ms, flip angle 300) in multiple breath-holds. The pattern of hyperenhancement representing MI (which intensity was more than 150% intensity of myocardium) was quantified by planimetry. The CE-MRI was scored according to the severity of myocardial scar as: 1--without scar, 2-- <50% of myocardial thickness, 3 - > 50% of myocardial thickness.
Myocardial perfusion was analysed using MCE and contrast-enhanced MRI in 362 segments. Agreement between MCE and CE-MRI for identification of viable versus necrotic myocardium on third day after PCI was 86% (kappa = 0.73). Thirteen (54%) patients showed transmural necrosis at CE-MRI while 11 (46%) showed non-transmural necrosis. Patients from the transmural necrosis group showed a higher creatine kinase peak (p = 0.0001), higher CK-MB (p = 0.00002) and higher troponine level (p = 0.008), and more impaired baseline regional contractile function (p = 0.045). All angiographic parameters were less favourable in this group before as well as after PCI than in patients with non-transmural necrosis.
Myocardial contrast echocardiography correlates very well with CE-MRI in the assessment of myocardial perfusion after PCI in AMI. Contrast-enhanced MRI is accurate technique for assessing the infarct zone. Identification by CE-MRI of transmural necrosis was associated with more impaired left ventricular function, non-reperfused MI, and presence of Q waves in ECG.
Kardiologia polska 08/2009; 67(8A):1013-8. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been shown to be associated with ventricular arrhythmias, however, its prognostic role in predicting sudden cardiac death has not yet been established.
To explore a potential relationship between LGE visualised by CMR and life-threatening ventricular tachyarrhythmia in hypertrophic cardiomyopathy (HCM).
The LGE in CMR was assessed in 55 HCM patients. We compared the frequency and extent of LGE in HCM patients with sustained ventricular tachycardia (VT) or who survived ventricular fibrillation (VF) or sudden death [group VF (+)] versus HCM patients without these tachyarrhythmias [group VF (-)]. There were 14 patients in the VF (+) group and 41 patients in the VF (-) group, and they were followed for a mean period of 37 months.
In group VF (+), adequate ICD intervention occurred in 9 patients (8 patients with VF and one patient with sustained VT), and VF arrest occurred in 5 patients (4 patients were resuscitated and one patient had a witnessed sudden death). In group VF (+) all patients had LGE whereas in group VF (-) 85% patients presented this abnormality (p = 0.13). Moreover, there were no statistical differences between groups in the following parameters: age, total left ventricular (LV) mass, maximal LV wall thickness, mass of hyperenhanced myocardium and percent of hyperenhanced myocardium.
In HCM patients with life-threatening ventricular tachyarrhythmia LGE was both qualitatively and quantitatively comparable with patients without these tachyarrhythmias.
Kardiologia polska 08/2009; 67(8A):964-9. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Data on the effects of oral antiplatelet agents on blood coagulation in vivo are conflicting. The platelet glycoprotein (GP) IIIa PlA2 allele has been suggested to modulate antithrombotic actions of clopidogrel.
We investigated whether clopidogrel combined with aspirin affects local thrombin formation and platelet activation triggered by vascular injury.
We studied patients with stable coronary artery disease on chronic aspirin therapy randomised to addition of clopidogrel 75 mg/d (n = 30) or continuation of aspirin 100 mg/d (n = 30) for 4 weeks. Markers of thrombin generation [thrombin-antithrombin complexes (TAT) and prothrombin 1.2 fragments (F1.2)] and markers of platelet activation [soluble CD40 ligand (sCD40L) and P-selectin] were determined in the supernatant of blood samples obtained from a microvascular injury site.
Total amounts of thrombin markers produced at the site of injury were similar before and after addition of clopidogrel, whereas platelet release of sCD40L and P-selectin was lower during treatment with aspirin + clopidogrel by 33.8% and 27.8% (p < 0.001), respectively. Patients in the highest tertile of reduction in platelet activation had previous myocardial infarction and peripheral arterial disease and released the highest amounts of sCD40L and P-selectin at baseline. TAT and F1.2 generation as well as sCD40L or P-selectin release were not influenced by the presence of the PlA2 allele.
Our study shows that clopidogrel combined with aspirin does not reduce thrombin formation following vascular injury, but attenuates platelet sCD40L and P-selectin release.
Kardiologia polska 07/2009; 67(6):591-8. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Statins produce additional beneficial effects, including attenuation of prothrombotic mechanisms. In patients at high cardiovascular risk, who have markedly elevated low-density lipoprotein (LDL) cholesterol levels, simvastatin can reduce thrombin generation. Moreover, we have described simvastatin-induced improvement of fibrin clot properties, the formation of which represents the final step of blood coagulation.
The aim of the present study was to assess the effect of simvastatin on fibrin features observed in subjects with LDL cholesterol <3.4 mmol/l.
Thirty subjects (24M, 6F) aged <70 years with LDL cholesterol <3.4 mmol/l with no history of cardiovascular events were enrolled in the study. Patients were excluded if they had diabetes mellitus, chronic inflammatory diseases and renal insufficiency. Prior to and following a 3-month treatment with simvastatin (40 mg/d), ex vivo plasma fibrin clot permeability and efficiency of clot lysis were measured.
Simvastatin led to a significant decrease in total cholesterol, LDL cholesterol, triglycerides and C-reactive protein (CRP), while fibrinogen levels remained unaltered. There were posttreatment increase in clot permeability by 4.4% (p<0.001) and shortening of clot lysis by 11.2% (p<0.001) compared to pretreatment values. These changes were correlated with reduction in CRP following simvastatin. Simvastatin-induced increase in clot permeability was associated only with age and decrease in CRP levels (R2 for the model = 0.61), while shortening of clot lysis time observed following simvastatin use was predicted only by reduction of triglycerides and CRP (R2 for the model = 0.62).
Simvastatin exerts unique properties involving enhanced fibrin clot lysis and increased clot permeability in subjects with LDL cholesterol <3.4 mmol/l, which is associated with its anti-inflammatory effects. Altered fibrin clot function might contribute to clinical benefits of statins.
Polskie archiwum medycyny wewnȩtrznej 06/2009; 119(6):354-9. · 2.05 Impact Factor