[Show abstract][Hide abstract] ABSTRACT: Introduction:
Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis.
The goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events.
Symptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n=215) or non-ST-elevation acute coronary syndrome (n=34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients.
Patients with HTPR were more frequently diagnosed with ischemic stroke (p=0.0351, OR=16.818, 95% CI [1.464-193.23]) and other ischemic cerebral events (stroke or TIA, p=0.0339, OR=6.5, 95% CI [1.36-31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p=0.0489, OR=10; 95% CI [1.39-71.80]).
HTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.
No preview · Article · Dec 2015 · Thrombosis Research
[Show abstract][Hide abstract] ABSTRACT: Background:
Patients with cyanotic congenital heart disease (CCHD) have an increased risk of bleeding and thrombotic complications. Prolonged conventional coagulation screening parameters, such as activated partial thromboplastin time or prothrombin time, are reported in less than 20% of CCHD patients.
The aim of this study was to determine the haemostatic abnormalities in 32 adult patients with CCHD by rotation thromboelastometry (ROTEM) with assessment of coagulation dynamic properties, as a guide for perioperative prophylaxis or haemostatic therapy. The control group consisted of 35 healthy subjects.
Our results suggest that CCHD patients, in comparison to healthy controls, had a tendency to hypocoagulate with delayed activation of haemostasis and clot formation, initiated by both intrinsic and extrinsic activators. The growth of the clot was slower and the clot firmness was decreased, which may additionally contribute to bleeding diathesis. Moreover, the clot lysis readings suggest higher clot stability in the CCHD group. All velocity parameters were markedly lower in the CCHD patients, indicating a decreased rate of clot formation. Although coagulation tests and platelet count were normal, the usefulness of rotation thromboelastometry in monitoring or guiding therapy in CCHD patients is demonstrated.
In conclusion, our results provide new insights into the data on hypocoagulation with impaired clot lysis in adult CCHD patients as determined by ROTEM. Our findings may assist in determining the optimal management of patients with CCHD undergoing surgery.
No preview · Article · Oct 2015 · International journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Recently the renewed interest in the balloon aortic valvuloplasty (BAV) occurred. The aim of our study was to analyze the indications and short-term outcome of BAV, since transcatheter aortic valve implantation (TAVI) was launched in our institution.
Between September 2010 and September 2014 twenty five consecutive patients (19 female, 6 male) underwent BAV. The mean age was 72±11.4 years, mean EuroScore II was 10.4%±11.7%, mean logistic EuroScore 23.5%±23.6%, mean STS mortality risk score was 21.8%±13.6%. The indications for BAV were: advanced haemodynamically unstable heart failure including cardiogenic shock or pulmonary oedema (n=7), co-morbidities requiring urgent non-cardiac surgery (n=8), palliative treatment (n=6) and an intension to bridge to TAVI or aortic valve replacement in patients with severe heart failure (n=4).
In-hospital mortality was 20% (n=5), and occurred in patients who underwent BAV in the setting of haemodynamically unstable heart failure. Other major complications included pacemaker implantation (n=2), major vascular complications (n=4) and cardiac tamponade (n=1). There were no patients who required conversion to cardiac surgery. The mean peak aortic transvalvular gradient decreased from 96.9±29.5 to 60.3±15.5mmHg (P=0.0001) after BAV. We did not observed significant aortic regurgitation.
Treatment of advanced and haemodynamically unstable aortic stenosis, bridge to non-cardiac surgery and palliative therapy are the main reasons for BAV in recent years. BAV as bridge to TAVI or aortic valve replacement may be an option for some patients. Short-term results are good with relatively low mortality and morbidity related to the procedure. Mortality in hemodynamically unstable patients presenting with cardiogenic shock or pulmonary oedema treated with BAV is very high.
Full-text · Article · Aug 2015 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: Recent studies reported existence of obesity paradox in acute coronary syndromes (ACS). However, occurrence of obesity paradox in men and women has not yet been thoroughly investigated, even though both genders differ in patterns and incidence of obesity. Therefore, the aim of this study was to investigate whether obesity influence on outcomes of patients with ACS varies by gender.
This retrospective study included 341 patients admitted to hospital for treatment due to ACS in 2012. They were classified according to World Health Organization with use of body mass index (BMI) as normal weight, overweight and obese. All patients received standard discharge medication. All-cause mortality was assessed during the mean follow-up time of 212 ± 121 days.
There were 82 normal weight (24%), 160 overweight (47%) and 99 obese patients (29%). There were 252 (73.9%) men. All-cause mortality was lower in the obese and overweight vs. normal weight male patients (1.4% vs. 3.3% vs. 13.1% respectively, p=0.009). There was a trend favoring the normal-weight and obese vs. overweight women (4.8% vs. 3.6% vs. 17.5% respectively, p=0.103). In the general population, after adjustment, BMI increase by one reduced risk by 15.6 % (p=0.015), and obesity reduced risk by 50.8 % (p=0.056). Obesity reduced risk for men by 69.4 % (p=0.015), and BMI increase by one reduced risk for men by 22 % (p=0.002). BMI and obesity were independent prognostic factors in men, whereas no such phenomenon could be observed in women.
Only male patients seem to contribute to the obesity paradox observed in patients with ACS. Obesity paradox does not occur in female patients when considered separately. Obesity seems to have a different influence on outcomes in both genders and this might be worthy of further studies.
Full-text · Article · May 2015 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: Background:
Pericardial effusion is an early complication following orthotopic heart transplantation. Effusion that requires surgical intervention not only prolongs in-hospital stay but also increases early mortality rate. EuroSCORE is one of the most common methods for calculating predictive mortality in heart surgery.
Material and methods:
We performed a retrospective analysis of 25 patients (22 men and 3 women, mean age 49±12 years). Mortality risk by EuroSCORE was estimated prior to surgery. All patients were operated on with Lower-Shumway technique and treated with standard triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and prednisolone). They were divided into 2 groups depending on postoperative pericardial effusion that required surgical intervention. There were 9 (36%) patients in the pericardial effusion group (PE group) and 16 (64%) in the control group (C group).
There was 1 death, on the 7th postoperative day, due to Clostridium difficile infection. Mean time of pericardial effusion echocardiographic detection was 9±2 days following surgery. The mean amount of fluid diagnosed in 4-chamber transthoracic echocardiography was 2.2±0.3 cm vs. 0.7±0.2 cm (p<0.05). Pericardial effusion followed thrombocytopenia of 98±17 vs. 172±26×10⁹/L in PE and C group (p<0.05). Patients' mean intensive care unit time stay was 23±9 days and 11±7 days in PE and C group, respectively (p<0.05). The overall hospitalization time was 38±12 days and 31±23 days in PE and C group, respectively (p<0.05). The discriminant analysis showed that EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion (AUC 0.946, CI: 0.76-0.99).
Pericardial effusion is a common (36%) complication following heart transplantation. It requires surgical intervention and prolongs intensive care unit stay and overall hospitalization. The discriminant analysis showed that the EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion.
[Show abstract][Hide abstract] ABSTRACT: Introduction: There is an increasing interest in comorbidities in heart failure patients. Data about chronic obstructive pulmonary disease (COPD) in the Polish population of heart failure (HF) patients are scarce. The aim of this study was to investigate the clinical characteristics, treatment differences and outcome according to COPD occurrence in the Polish population of patients participating in the ESC-HF Pilot Survey Registry.
Material and methods: We analyzed the data of 891 patients with HF recruited in 2009–2011 in Poland: 648 (72.7%) hospitalized patients and 243 (27.3%) patients included as outpatients.
Results: The COPD was documented in 110 (12.3%) patients with HF in the analyzed population. Patients with – compared to those without – COPD were older, more often smokers, had higher NYHA class, and higher prevalence of hypertension. Ejection fraction (EF) was higher in hospitalized patients with COPD compared to patients without COPD (40.5 ±14.6% vs. 37.2 ±13.7%, p < 0.04), without a significant difference in the outpatient group. There was a significant difference in β-blocker use between patients with and without COPD (81.8% vs. 94.7%, p < 0.0001). Most patients received them below target doses. At the end of the 12-month follow-up, there was no significant difference in mortality between COPD and no-COPD patients (10.9% vs. 11.1%, p = 0.66).
Conclusions: The findings from the Polish part of the ESC-HF registry indicate that COPD in patients with HF is associated with older age, smoker status, hypertension and higher NYHA class. The use of β-blockers was significantly lower in patients with than without COPD. There were no significant differences in mortality between groups.
Full-text · Article · Jan 2015 · Archives of Medical Science