Jacek Piegza

Medical University of Silesia in Katowice, Catowice, Silesian Voivodeship, Poland

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Publications (22)65.14 Total impact

  • No preview · Article · Oct 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Objectives: The aim of the study was to assess the incidence of depression and anxiety symptoms in patients after cardiac arrest (SCA) in relation to patients with a history of myocardial infarction without SCA and in healthy individuals. The analysis of the impact of selected socio-demographic and clinical parameters and duration of SCA on the presence and severity of depression and anxiety symptoms in different groups was also performed. Methods: The study involved 30 patients after SCA and 31 patients with a history of myocardial infarction without SCA. The control group consisted of 30 healthy subjects. To assess the mental state, a specially developed questionnaire was used, while the presence and severity of the symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HAM-A). Results: Statistically, a significantly higher average level of depression and a higher incidence of anxiety was demonstrated in patients after a sudden cardiac arrest (study group) and after myocardial infarction (reference group) compared with the control group. There were no statistically significant differences in the incidence of anxiety between the study and reference groups. No impact of the duration of cardiac arrest on the incidence of depression and anxiety symptoms in the study group was observed. Conclusions: In the group of people with a history of cardiac arrest, the most common mental disorder is depression. Anxiety and depression are significantly more frequent in patients with a history of SCA than in healthy individuals. There were no differences in the incidence and severity of depression symptoms in patients after SCA compared to patients after myocardial infarction without SCA. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety in the investigated groups.
    No preview · Article · Aug 2015 · Psychiatria polska

  • No preview · Article · Sep 2014 · Journal of the American College of Cardiology
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    ABSTRACT: The examination referred to two groups of female patients: with and without significant coronary stenoses in coronarography. There were two stages of the examination: before and 6-9 months after coronarography. The factor dividing patients into two groups: without significant atheromatosis and with coronary atheromatosis, was the result of invasive diagnostics of coronary heart disease. The sense of coherence scale (SOC-29) and sociodemographic questionnaires were used to evaluate the condition of the two groups. In group of patients with irrelevant coronary stenoses statistically lower values of sense of comprehension were noticed in the first and the second examination and also sta- tistically lower values of sense of manage were observed, comparing to the group of patients with significant stenoses. The initial value of general coherence was comparable in both groups and did not significantly change in 6-9 months after coronarography. The characteristic parameters: lack of social support, intensity of depressiveness and anxiety before getting information about necessity of coronarography and worse education were connected with lower sense of coherence. The baseline strength of the total sense of coherence was not different between groups. Patients with no significant stenosis of coronary arteries demonstrate a lower sense of comprehensibility before and after the coronary arteriography and lower sense of manageability after the procedure compared to the group of patients with significant atherosclerotic lesions. No social support, tendency for depression and anxiety and lower level of education were associated with lower sense of coherence in both groups.
    No preview · Article · Sep 2014 · Psychiatria polska
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    ABSTRACT: The following description presents a case of a 75-year-old female patient with non-ST-segment elevation acute coronary syndrome in whom there occurred an infrequent complication of percutaneous coronary angioplasty: uncontrolled intracoronary stent displacement from a balloon catheter. During the attempt to retrieve the device using the "small-balloon" technique, further slippage of the stent from the balloon catheter to the right deep femoral artery was observed. Therefore, it was decided to provide a commercial intravascular microloop, whereby the stent was successfully retrieved outside the vascular system.
    Full-text · Article · Jun 2014 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
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    ABSTRACT: Transcatheter aortic valve replacement (TAVR) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high risk and surgically in operable patients who suffer from severe symptomatic aortic stenosis. However, a significant number of complications, associated with both the learning curve and device specificity, have required attention and subsequent improvement. The Symetis transapical TAVR system is a self-positioning bioprosthesis composed of a non-coronary leaflet of surgical quality porcine tissue valve sewn into a self-expanding nitinol stent that iscovered with a PET-skirt. From June to September 2013 six patients have been operated on severe aortic stenosis using the new TAVR device. All patients have undergone critical assessment of a local Heart Team and have been disqualified from conventional AVR. Five were woman. Mean age was 82.3 ± 2.0 (mean LogEuroScore 23.9 ± 14.3). Four patients suffered from coronary artery disease - two had history of previous percutaneous coronary intervention with intracoronary stents, while the next two had history of coronary artery bypass grafting. Diabetes was frequent (n = 3) as well as chronic obstructive pulmonary disease (n = 4). Carotid artery disease was encountered in three patients similarly to atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 51.5 ± 11.8%, but one patient had suffered from low-flow-low-gradient aortic stenosis with LVEF of 29%. The procedure was carried out successfully in all six cases. Two patients have received the valve sized L, three - M and one - S. Mean procedure time was 180 ± 19 min, mean cine 7.2 ± 1.2 min. Mean X-ray dose 930 ± 439 mGy, while mean volume of contrast given was 135 ± 61 mL. In all patients but one perivalvular leak (PVL) was not present. One patient had trace of PVL. Also, good LVEF was noted in all patients. Similar findings were obtained 30 days post procedure. No strokes, transient ischaemic attack or other cerebrovascular incidents were observed. This brief clinical communication reports the first Polish experience with the second generation of TAVR device - the Symetis Acurate Transapical Aortic Valve. While it lacks large patient population and longer follow-up, it reveals that TAVR procedure can be performed safely, with minimal X-ray exposure time and contrast given and successfully - with almost nonexistent PVL and no cerebrovascular incidents or heart rhythm disturbances. Heart Team approach is vital, and transapical access should not be treated inferiorly, but rather as an equally appealing TAVR option.
    Full-text · Article · Mar 2014 · Kardiologia polska
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    ABSTRACT: Anxiety is a common and serious problem in ischemic heart disease. Anxiety associated somatisation disorders may imitate symptoms of coronary disease or coexist with ischemic heart disease. Despite multiple visits to various specialists patients with somatisation are frequently misdiagnosed and therefore mistreated. Extraction of patients with anxiety disorders from the group of patients complaining of chest pain is a necessary condition for appropriate management. Coronary angiography is a test that by its nature can give rise to anxiety. However, dynamics of that anxiety may be variable depending on coexisting mental disorders. Purpose of this study was determination if presence of serious atheromatous lesions in coronary arteries differentiates the anxiety level changes following coronary angiography. A group of 90 female patients examined with coronary angiography was divided into two subgroups: the first one was 48 patients without serious stenoses in coronary vessels; the other was 42 patients with confirmed serious atheromatous lesions. Dynamics of anxiety level changes from the moment of admission to the hospital, through the post-examination period, and until the period between 6th and 9th month after coronary angiography was evaluated with three-time measurement of anxiety using the Spielberger's State-Trait Anxiety Inventory. Intensity of anxiety as a trait was also measured two times (at the first and third examination). Intensity of anxiety as a state was the highest in both subgroups at the first measurement. At the second measurement a significant reduction was observed, more pronounced in the subgroup without serious coronary problems. At the third measurement women with confirmed serious lesions in coronary arteries demonstrated the lowest level of anxiety, and in the subgroup of patients without any serious coronary stenoses the level of anxiety increased compared to the second measurement. At the third measurement, women with excluded or insignificant atheromatous lesions presented significantly higher level of anxiety compared to the group with serious stenoses of coronary arteries. At the final measurement, intensity of anxiety as a trait was significantly lower in the group of patients with confirmed serious coronary stenoses. In women demonstrating no serious atheromatous lesions in coronary arteries on coronary angiographic examination anxiety does not recede permanently, but reappears after several months. In that group consideration of diagnosis of anxiety disorders in form of somatoform disorders seems justified. Those patients should be offered a psychiatric therapy.
    No preview · Article · Aug 2013 · Kardiologia polska
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    ABSTRACT: The aim of this study was to evaluate the influence of sociodemographic and clinical factors on symptoms of depression in 90 female patients awaiting coronarography. The factor dividing the patients into two groups: those without significant atheromatosis - 48 women and those with coronary atheromatosis - 42 women, was the result of invasive diagnostics of coronary heart disease. BDI (Beck Depression Inventory), HAM-D (Hamilton Depression Rating Scale) and sociodemographic and clinical data questionnaire were used in the study. It was proved that there was a connection between the appearance of increased parameters of depression and more frequent number of annual visits in the Primary Care or Cardiologic Clinic, higher level of depressiveness and anxiety, fear of obtaining information applying to the necessity of coronarography, lack of hormonal replacement therapy and of support from other people. Additionally, it was noticed that the intensity of symptoms were higher for those less educated, those waiting shorter for coronarography and those with hypertension. There were no statistically significant differences in the estimation of depressive states in both groups, neither in prevalence, nor in the intensity. Patients with increased parameters of depression need special therapies and multidisciplinary care.
    No preview · Article · Jan 2008 · Psychiatria polska
  • A. Lekston · J. Piegza

    No preview · Article · Jan 2008 · Kardiologia polska
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    ABSTRACT: Due to recent advances in stent design, stenting without balloon predilation (direct stenting) has become more extensively used in patients with acute myocardial infarction (AMI). We performed a randomized study with broad inclusion criteria and early randomization after presentation to compare direct stenting with stenting after balloon predilation in patients with AMI. A total of 248 patients was randomized. After exclusion of patients not suitable for stenting, the final study group comprised 217 patients. Direct stenting strategy was feasible in 88% of patients with no meaningful complications. Final Thrombolysis In Myocardial Infarction grade 3 flow (96% vs 94%), final Thrombolysis In Myocardial Infarction myocardial perfusion grade 2 or 3 (68% vs 61%), and average ST-segment resolution after the procedure (49% vs 51%) were similar in the direct stenting and predilation groups, respectively (p = NS). Rate of in-stent restenosis was higher in the direct stenting group (30% vs 16%, p = 0.024), which was due to a worse angiographic result after the procedure. At 5 years, a composite of cardiac death, reinfarction, and target lesion revascularization had occurred in 39% in the direct stenting group and 34% in the predilated group (p = 0.40). In conclusion, although at 5 years clinical outcome did not differ significantly between groups, direct stenting was associated with a higher incidence of in-stent restenosis at 1 year. Direct stenting did not improve epicardial and myocardial reperfusion indexes. Direct stenting strategy should not be recommended in all patients with AMI as an alternative strategy to stenting after predilation.
    No preview · Article · Oct 2007 · The American Journal of Cardiology
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    ABSTRACT: Femoral artery pseudoaneurysms (PSA) develop in 0.2-8% patients undergoing procedures that require femoral artery cannulation. Ultrasound guided thrombin injection has been described as successful and safe alternative to ultrasound guided compression and surgical treatment. Assessment of efficacy and safety of PSA treatment with USGTI. 28 patients (pts) (18 female, mean age 64.6 +/- 11.4) with femoral pseudoaneurysms developed due to coronary angiogram or percutaneous coronary angioplasty were treated with ultrasound guided thrombin injection. 24 PSAs arose from right common femoral artery, 3 from right superficial femoral artery, and 1 from left common femoral artery. 24 patients were receiving antiplatelet and 4 anticoagulation therapy at the time of the procedure. With ultrasound guidance, a 21Gx11/2 needle was placed into pseudoaneurysm lumen followed by thrombin injection (1074 +/- 473 U). No complications of the procedure were observed. In 24-hour observation USGTI was successful in 28 (100%) patients. However, in 7-day follow-up resolution of 1 PSA was found, which reduced efficacy rate to 96.3%. Ultrasound guided thrombin injection is a successful, safe and well tolerated method of pseudoaneurysms treatment. Neither antiplatelet nor anticoagulation therapy affects success rate of the method.
    No preview · Article · Nov 2005 · Polskie archiwum medycyny wewnȩtrznej
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    ABSTRACT: Background: Femoral artery pseudoaneurysms (PSA) develop in 1-6% of patients undergoing procedures that require femoral artery cannulation. Utrasound guided thrombin injection has been described as a successful and safe alternative to ultrasound guided compression and surgical treatment. Material and methods: With ultrasound guidance, a 21 G × 1/2" needle was placed into the pseudoaneurysm lumen followed by thrombin (700-800 U) injection. Case 1: Thrombin injection into false aneurysm was performed in 53 year old female patient with mechanical aortic prosthesis. In 24-hour-observation the procedure appeared successful despite oral anticoagulation treatment. Control ultrasound 7 days after the procedure revealed complete resolution of the PSA. Despite changing anticoagulation treatment from oral to low molecular weight heparine, the following attempt to obliterate PSA with thrombin was unsuccessful. Case 2: Successful thrombin injection into post-PCI PSA was performed in a 71 year old female patient. There was no complication of the procedure. Injection of thrombin into PSA resulted in immediate total PSA obliteration, which was successful in short and long term observation despite antiplatelet drug administration. Conclusions: We believe that failure to close PSA with thrombin was due to PSA morphology, including broad and short PSA neck and high velocity of inflow into PSA. Preliminary experience with PSA obliteration with thrombin show that this method of treatment might be superior to traditional surgery or ultrasound guided compression.
    No preview · Article · Jan 2005 · Folia cardiologica

  • No preview · Article · Mar 2004 · Journal of the American College of Cardiology
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    ABSTRACT: Carotid artery stenting (CAS) is, apart from surgical endarterectomy, a common method of treatment of atherosclerosis in carotid arteries. Percutaneous angioplasty of carotid artery narrowings has been developing in recent years due to introduction of neuroprotection systems, which significantly reduced number of complications. Nowadays three neuroprotection systems are in common use: filters, temporary occlusion and aspiration systems and flow reversal systems. We present three cases of successful CAS with application of three different neuroprotection systems. We discuss indications, contraindications and limitations of every device.
    No preview · Article · Feb 2004 · Przegla̧d lekarski
  • P. Trzeciak · J. Piegza · M. Świerad
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    ABSTRACT: The case of a 64-year-old man with aortic valve disease diagnosed a few years earlier is presented in the paper. Five months before hospitalization the patient started to suffer from dizziness and balance disturbances that were associated with valve disease. Due to the difference of blood pressure found in upper limbs (30-40 mm Hg) the left subclavian artery angiography was also made at the time of coronary angiography. Severe stenosis in the proximal segment of the left subclavian artery was diagnosed. Ballon angioplasty with stenting was performed with successful angiographic result, the equalization of blood pressure values on upper limbs, and symptoms withdrawal. In the follow-up period, after aortic valve replacement, patient remains without complaints, with equalized blood pressure values.
    No preview · Article · Jan 2004
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    ABSTRACT: Although the introduction of primary percutaneous coronary interventions (PCI) improved the outcome of patients with acute myocardial infarction (MI), diabetes remains a significant factor which worsens prognosis. To compare the immediate and in-hospital results of PCI in patients with acute MI with or without diabetes. The outcome of 139 patients with diabetes and 528 patients without diabetes was compared. Thrombolytic therapy was administered prior to PCI to 43.2% of patients with diabetes and 42.4% of patients without diabetes. Patients with diabetes were older, more frequently of female gender and had higher incidence of hypertension as well as multi-vessel coronary artery disease. PCI was effective in 85.6% of diabetics and 90.2% of non-diabetic patients (NS). The reocclusion rate was significantly higher in diabetics than in non-diabetics (11.5% vs 5.5%, p=0.012) whereas the incidence of haemorrhagic complications was similar. Mortality rates were comparable in both groups (7.2% in diabetics vs 5.9% in non-diabetics, NS). 1) Immediate efficacy of primary PCI for acute MI is similar in diabetics and non-diabetics, however, the in-hospital reocclusion rate is higher in the former group of patients. 2) In-hospital mortality is not affected by the presence of diabetes. 3) Thrombolytic and invasive treatment of diabetic patients with acute MI is not associated with an increased risk of bleeding.
    No preview · Article · Jul 2003 · Kardiologia polska
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    ABSTRACT: Background: Despite stenting, recanalisation of chronic total occlusions (CTO) is connected with higher restenosis and reocclusion rates as compared to angioplasty of patent arteries. The aim of the study was to assess the early and late effect of abciximab therapy during recanalisation of CTO of left anterior descending artery (LAD). Material and methods: Out of 55 patients with CTO of LAD in whom recanalisation procedure was attempted, in 41 patients (75%) the occlusion was crossed with a guidewire. They were randomised to abciximab group (21 patients) or control group, (20 patients). Abciximab (bolus + infusion) was started after successful guidewire placement. Two patients (one per group) were subsequently excluded because of not receiving a stent. Final study groups comprised 20 and 19 patients in the abciximab and control groups. Clinical and angiographic follow-up was performed at 9.8 ± 3.6 month in all patients. Results: Baseline characteristics of the 2 groups were comparable. Early procedural success (stenosis < 50% and TIMI flow grade 3) was achieved in all patients. Restenosis (about 40%) and reocclusion (about 15%) rates were similar in both groups. Clinical outcome at follow-up was comparable in the groups: recurrent ischemia 30% vs. 32%, reinfarction 10% vs. 0%, death 0% vs. 0% in abciximab and control groups respectively (p = NS for all). Significant improvement in left ventricular ejection fraction was noted in all the patients (before recanalisation 47.4 ± 7.4%; at follow-up 51.0 ± 9.2%; p = 0.025). Conclusions: An abciximab therapy during recanalisation of CTO of left anterior descending artery does not affect the early and late clinical and angiographic outcomes. Recanalisation procedure results in the improvement of left ventricular ejection fraction.
    No preview · Article · Jan 2003
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    ABSTRACT: Background: Smoking is one of the major cardiovascular risk factors. Data concerning angioplasty for acute myocardial infarction and smoking are limited. The aim of this study was the comparison of smoking and non-smoking patients treated by angioplasty for acute myocardial infarction. Material and methods: A total of 1176 consecutive patients with acute myocardial infarction treated by immediate angioplasty from January 1998 to December 2002 were included in the analysis. The two groups were compared: 750 (63.80%) smokers and 426 (36.2%) non-smokers. Results: Smokers were younger and less frequently of female sex. Hypertension and diabetes mellitus were less common in the smokers group. Cardiogenic shock on admission was less frequently in the smokers (16.0% vs. 8.0%; p < 0.001). Right coronary artery was more frequent the infarct related artery in the smokers group. Multivessel coronary artery disease was observed less often in the smokers. A total of 3.7% of smokers died in the hospital compared to 8.5% of non-smokers, p = 0.00061. In the multivariate analysis smoking was not an independent predictor of death (odds ratio: 0.57; 95% confidence interval = 0.24-1.47; p = 0.26). Conclusions: Better outcome of smokers with acute myocardial infarction treated by immediate angioplasty results from differences in the baseline characteristics which have crucial impact on outcome.
    No preview · Article · Jan 2003 · Folia cardiologica
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    ABSTRACT: The aim of this study was to characterize the immunohistological components of chronic inflammation in endarterectomy lesions. Therefore, in 24 patients endarterectomy specimens were obtained from coronary arteries during CABG surgery (16 from RCA and 8 from LCA) and immunohistologically analyzed using avidin-biotin method (LSAB(R)/AP) with monoclonal antibodies. Macrophages and CD3 lymphocytes were counted under 200x magnification but MHC class II and ICAM-1 adhesion molecules were analyzed semi-quantitatively (scale from 0 to 3+). The mean macrophages density was 47.8+/-9.8 cells per mm2 and mean CD3 lymphocyte density was 1.3+/-0.6 cells per mm2. Lack or weak expression of HLA-DR (0-1+) on macrophages was found in 17 of 24 cases (70.8%). In the remaining seven cases (29.2%) there was a moderate and strong expression (2+ and 3+) of HLA-DR antigens. Similarly, no or weak ICAM-1 expression on macrophages was detected in 19 cases (79.2%). These cells were positively stained for ICAM-1 in only five cases (20.8%). Our data suggest that in advanced primary atherosclerotic lesions chronic inflammation is still present. On the other hand, the small number of activated inflammatory cells and the absence of positively stained endothelium suggests that inflammatory process tends to be burnt-out.
    Full-text · Article · Jul 2002 · Cardiovascular Surgery
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    ABSTRACT: Introduction: Cardiogenic shock (CS) is the most frequent cause of death in patients with acute myocardial infarction. The aim of the study is to compare in-hospital outcome of patients with acute myocardial infarction treated by immediate angioplasty with and without cardiogenic shock. Material and methods: Consecutive patients treated by immediate angioplasty for acute myocardial infarction were analysed: 58 patients with CS and 588 without CS. Results: Cardiogenic shock patients were older (59.7 ± 11.3 years vs. 56.3 ± 11.3 years; p = = 0.014), time from onset of acute myocardial infarction was longer (6.1 ± 5.2 hours vs. 4.3 ± ± 2.6 hours; p = 0.004), more frequent have the history of myocardial infarction (32.1% vs. 20.2%; p = 0.017) and multivessel disease (72.1% vs. 48.0%; p < 0.0001). Cardiogenic shock patients have lower rates of final TIMI flow grade 3 (65.0% vs. 92.3%; p < 0.0001). Left ventricular ejection fraction was lower in CS patients (40% ± 9% vs. 45% ± 8%; p < 0.0001). The need for urgent CABG was observed in 7.6% CS pts and in 0.7% patients without CS (p < 0.0001). Gastrointestinal bleeding was more frequent in CS patients (6.3% vs. 0.2%; p < 0.0001). In-hospital mortality was higher in CS patients (38. 0% vs. 1.9%; p < 0.0001) but after successful angioplasty was 19.2%. Conclusions: Factors predisposing to cardiogenic shock in acute myocardial infarction are: older age, prior myocardial infarction, lower left ventricular ejection fraction and multivessel disease. Restoration of normal flow in infarct related artery significantly reduce in-hospital mortality in cardiogenic shock. Thrombolytic treatment before angioplasty do not influence in-hospital course of CS pts, and the potential benefits of early flow restoration are markedly reduced by hemorrhagic complications.
    Full-text · Article · Jan 2002 · Folia cardiologica

Publication Stats

33 Citations
65.14 Total Impact Points


  • 2004-2015
    • Medical University of Silesia in Katowice
      Catowice, Silesian Voivodeship, Poland
  • 2014
    • Silesian University of Technology
      Gleiwitz, Silesian Voivodeship, Poland
  • 2002-2014
    • Śląskie Centrum Chorób Serca
      • Department of Cardiac Surgery and Transplantology
      Hindenburg, Silesian Voivodeship, Poland